GEORGIA SYSTEM OF CARE STATE PLAN 2017 · GEORGIA SYSTEM OF CARE. STATE PLAN 2017. Created by the Interagency Directors Team, Pursuant to O.C.G.A. § 49-5-220. Prepared by the Center

GEORGIA SYSTEM OF CARESTATE PLAN 2017

Created by the Interagency Directors Team,Pursuant to O.C.G.A. § 49-5-220

Prepared by the Center of Excellence for Children’s Behavioral Health

CENTER OF EXCELLENCE FOR CHILDREN’S BEHAVIORAL HEALTH

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AcknowledgementsThe Georgia Interagency Directors Team (IDT) wishes to acknowledge the contributions of the many people and organizations listed below who assisted in gathering the documents and information that provided both foundation and direction for this plan, along with the hard work of so many that contributed to the creation of this plan.

IDT Member Organizations

State Agencies

Partner Organizations

Consulting Member• Centers for Disease Control and Prevention (CDC)

• Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD)*• Georgia Department of Community Health (DCH)• Georgia Department of Early Care and Learning (DECAL)• Georgia Department of Education (DOE)• Georgia Department of Human Services (DHS), Division of Family and Children Services

(DFCS)• Georgia Department of Juvenile Justice (DJJ)• Georgia Department of Public Health (DPH)• Georgia Vocational Rehabilitation Agency (GVRA)

• Amerigroup Community Care• CareSource (as of January 2017)• Center of Excellence for Children’s Behavioral Health (COE), Georgia State University• Center for Leadership in Disability, Georgia State University• Children’s Healthcare of Atlanta (CHOA; as of January 2017)• Georgia Alliance of Therapeutic Services for Children and Families (GATS)• Georgia Parent Support Network (GPSN)• Get Georgia Reading – Campaign for Grade Level Reading• Peach State (as of January 2017)• The Carter Center• Together Georgia• Voices for Georgia’s Children• WellCare (as of January 2017)

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• Linda McCall, LCSW (DCH, IDT Chair 2017)

• Kristen Toliver, MSW (DFCS, IDT Co-Chair, 2017)

• Christine Doyle, MSW, PhD (DJJ, IDT Chair 2016)

• Marcey Alter, MBA, MHA (DCH)• Cassa Andrews (DECAL)• Rebecca Blanton (DOE)• Jennie Couture, MEd (DECAL)

• Cheryl J. Dresser, MPA (GATSFC)• Monica Johnson, MA, LPC (DBHDD)• Danté McKay, JD, MPA (DBHDD)• Dawne R. Morgan (DBHDD)• Nakeba Rahming, EdS (DOE)• Erica Fener Sitkoff, PhD (GaVoices)• Sue L. Smith, EdD (GPSN)• Wendy White Tiegreen, MSW (DBHDD)

National Training and Technical Assistance Center for Children’s Behavioral Health (TA Network) The TA Network is a partnership of 13 organizations with expertise in systems of care for children, led by the Institution for Innovation and Implementation at the University of Maryland, School of Social Work.

IDT State Plan Workgroup Members

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Center of Excellence for Children’s Behavioral Health, Georgia State University*DBHDD, in partnership with the Georgia Health Policy Center, founded the Center of Excellence(COE), funds the operations of the IDT, and funded the backbone support from the COE in this effort.

Behavioral Health Coordinating Council

• Commissioner Judy Fitzgerald (DBHDD,BHCC Chair 2017)

• Commissioner Frank W. Berry (DCH,BHCC Vice Chair 2017, DBHDD, BHCC

Chair 2016)• Commissioner Clyde Reese (DCH, BHCC

Vice Chair 2016)• Stanley Jones, Esq. (Family Member of

Consumer, Secretary 2017)• State School Superintendent Richard

Woods (DOE)• Commissioner Camilla Knowles (DCA)• Commissioner Mark Butler (DOL)• Representative Katie Dempsey

(District 13)

• Commissioner Brenda Fitzgerald, MD(DPH)

• Commissioner Robyn A. Crittenden (DHS)

• Chairman Terry E. Barnard (State Boardof Pardons and Paroles)

• Commissioner Avery D. Niles (DJJ)• Commissioner Homer Bryson (DOC)• Commissioner Michael Nail (DCS)• Lavinia Luca, Disability Services

Ombudsman (ODSO)• Senator Renee Unterman (District 45)• Diane Reeder (Parent Representative)• Julie Spores (Adult Consumer)

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Table of ContentsExecutive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Background of System of Care (SOC) – Nationally and in Georgia . . . . . . . . . . . . . . . . . . . . . . . . . . 10 DefinitionsandValues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10History of SOC – Key Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Why Does Georgia Need a SOC Plan Now? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Focus and Scope of the SOC State Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Roles of the IDT and BHCC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15SOC Plan Development: Methods and Structure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Review and Integration of Other Documents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17IDT and Larger Stakeholder Input . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Georgia’s System of Care State Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Conceptual Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Goal Statements, Strategies, and Action Items . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Coordination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Workfor Dece velopment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Funding and Financing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Implementation Plan and Timeframe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Summary and Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

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Executive SummaryThestateofGeorgiahasmadesignificantinvestmentsinprogramstoimprovechildren’smentalhealthoverthepast30years.Withinthepastfivetosixyears,Georgiahasseenaflurryofactivities,programs, and funding aimed at improving children’s mental health. The success of these programs has been enhanced by interagency collaboration and communication. The 2017 Georgia System of Care (SOC) State Plan outlined in this report is the result of a renewed commitment to improving mental and behavioral health services for Georgia’s children on behalf of state child-serving agencies, legislators, and community organizations representing youth, family, and providers.

SOC is an organizational framework for how behavioral health services and supports delivery systemscanworktogethertofittheneedsofacommunity,county,region,orstate.TheSOCframework is based on three core values: child-, family-, and person-centeredness; being community-based; and cultural competency. From 1984 to the present, Georgia has made numerous investments to develop its SOC. It is crucial that at this moment, with such a large amount of activity and investment in children’s behavioral health, to create a new SOC to help support successful outcomes for Georgia’s children.

Children, adolescents, and emerging adults (ages 4-26) with severe emotional disturbance (SED) are the focus of the 2017 Georgia SOC State Plan, as they are a prevalent, vulnerable population that requires an SOC approach to service and support delivery to truly function and thrive. Historically, when services and supports are delivered in a manner that is not in line with SOC core values or guiding principles, children, adolescents, and emerging adults with SED are at an increased likelihood of facing diminished functioning, with negative, recurrent, and more costly systemsinteractionsoverthecourseoftheirlives.InGeorgiainstatefiscalyear(SFY)2014,stateagencies served over 100,000 children, adolescents, and emerging adults with SED and spent an estimated $263,976,378 of state funds on SED services and supports. The 2017 Georgia SOC State Plan aims to decrease costs and strains across systems while improving quality and access to care by streamlining and coordinating care for this vulnerable population.

In 2011, Georgia’s Department of Behavioral Health and Developmental Disabilities (DBHDD) created the Interagency Directors Team (IDT), which was composed of director-level members from all child-serving agencies in Georgia, as well as partner organizations. The IDT is the state’s multiagency SOC leadership collaborative, whose mission it is to manage, design, facilitate, and implement the SOC in Georgia. Over 15 months (March 2016–May 2017), under direction of the Behavioral Health Coordinating Council (BHCC), and with the support of the Center of Excellence for Children’s Behavioral Health and the National Training and Technical Assistance Center for Children’s Behavioral Health, the IDT developed the 2017 Georgia SOC State Plan.

TheIDTidentifiedthefivefocusareasofthisplan:Access, Coordination, Workforce Develop-ment, Funding and Financing, and Evaluation. Access and Coordination were deemed the most critical areas of focus. Workforce Development and Funding and Financing strategies can be conceptualized as methods through which to increase Coordination and Access. Evaluation wraps around the entire plan and feeds back into future planning efforts. Each focus area is aligned to a goal as well as short- and long-term strategies for achieving these goals. The timeline for implementation and summary of measures used to assess the success of the strategies that make up the 2017 Georgia SOC State Plan can be found later in this document.

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Access

Access to an array of community-based services and supports is a core component of any functional behavioral health care system. For children and emerging adults, access to mental health services iscriticallyimportantforearlyidentificationofmentalhealthconcernsandlinkagetoappropriateservices. A focus on access was chosen to support children and families in their access to and navigation of mental health care services in Georgia. Short-term strategies to increase access to care include service mapping for behavioral health service utilization, increasing behavioral health services in schools, and improving families’ abilities to navigate the current system. Long-term strategies include recruiting practitioners in shortage areas, strategically increasing the use of telemedicine and telehealth services, and increasing continuity of care.

Coordination

At the heart of the SOC approach are coordination and collaboration between child-serving agencies and organizations, and between the child, family, and the larger system. Coordinated communication systems between local, county, regional, and state bodies are a vital feedback loop to ensure that local and regional needs and resources are understood, and state and county-level policy objectives are being achieved. This area of focus was chosen as an integral part of a coordinated network that serves children and families. Short-term strategies to increase coordination include increasing training on SOCs for stakeholders and building and maintaining feedback loops between local, regional, and state agencies and systems. Long-term strategies include creating and utilizing a common language as it relates to discussing SOC principles, and addressing gaps in the crisis continuum by adding additional levels of care that will address capacity and acuity concerns: Crisis Respite; Intensive Care Coordination (IC3), and therapeutic foster homes.

Workforce Development

The behavioral health workforce in the United States is inadequate to meet current and growing service demands and behavioral health needs. Workforce issues can be compounded by geographic regions and characteristics, with rural areas at even more risk of experiencing workforce shortages. AsoverhalfofGeorgiacountiesaredesignatedasrural,theIDThasidentifiedworkforceasamajorbarrier to access to care for children and families. To develop, maintain, and support a culturally competent, trauma-informed workforce to meet the needs of children and youth, short-term strategiesincludingtargetedexpansionofeducationalandfinancialincentivestoaddressbehavioral health workforce shortages and developing a clearinghouse of evidence-based educational materials that will be employed along with the long-term strategy of developing a state mental health workforce plan across agencies.

Financing

Cross-agencycommitmenttoeffectiveandefficientspendingisnecessaryforacomprehensive,community-based, family-driven, youth-guided, culturally competent and trauma-informed SOC framework to operate in Georgia. The braiding and blending of interagency funds is a key way for multipleagenciestoachievemoreeffectiveandefficientspending.Intheshortterm,strategiestosolidify interagency funding of the IDT as the oversight body for the SOC in Georgia and create and utilize SOC guiding principles for contract development will help to address this focus area. The long-termstrategiestoestablishfundingandfinancingfortheSOCconsistofreviewingfinancialmappingreportstofindopportunitiestobraidorblendfundingandthecollaborationofIDTagencies in applying for and releasing funding opportunities and procurements when behavioral health is a key component.


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Evaluation

Ongoing evaluation of Georgia’s child-serving systems is critical to sustainability and success. To ensure that the proposed SOC is achieving its desired goals, the IDT will review evaluation tools to identify key metrics applicable to Georgia and provide these tools to the state, local, and regional teams as well as other child-serving systems to self-evaluate their SOC work. The long-term strategy for evaluation is for the IDT to institute and maintain a continuous quality-improvement process utilizingidentifiedmetricsthatwillbereviewedannuallyandregularlyreportedtotheBHCC.

The following report is composed of four key parts that make up the 2017 Georgia SOC State Plan. First, the background of the SOC framework and the history of how this plan was created are described, including the need for a SOC in the state of Georgia and the plan development methods and structure. Then, the current landscape in Georgia is examined. Next, the proposed 2017 Georgia SOC State Plan is presented, including the conceptual framework, goal statements, strategies, and action itemsforeachofthefivefocusareas.Finally,thetimelineforimplementationandsummaryofmeasures for the SOC State Plan are outlined in detail.

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IntroductionBackground of System of Care — Nationally and in Georgia

Definitions and ValuesAccordingtofederaldefinition,theSystemofCare(SOC)frameworkinvolves“aspectrumofeffective, community-based services and supports for children and youth with or at risk for mental health or other challenges and their families, that is organized into a coordinated network, builds meaningful partnerships with families and youth, and addresses their cultural and linguistic needs, in order to help them to function better at home, in school, in the community, and throughout life.” (Stroul, Blau, & Friedman, 2010). SOC is an organizational framework for how a mental or behavioral health services and supports delivery system should work (not a program or intervention) and canbeadaptedtofitanycommunity,county,region,orstate.

Figure 1. SOC Approach to Service and Support Delivery

The framework, initially articulated by Beth Stroul and Robert Friedman in A System of Care for Children with Severe Emotional Disturbance (1986), focused on children with serious disorders. These values and core principles are now also being used to develop effective service-delivery systems for all children, including those with or who are at risk of emotional and behavioral problems. Over the past 30 years, SOC has become an increasingly prevalent guiding philosophy for the provision ofchildren’smentalhealthservices,includingtheintegrationofscientificevidence-basedpracticesinto a formal systems framework. The SOC approach is based on three core values: child-, family-, and person-centeredness; being community-based; and cultural competency. These values are further supported by 13 guiding principles (detailed in Appendix A).

Core Value: SOC should be community-based, with the locus of services as well as management and decision-makingresponsibilityrestingatthe community level.

Core Value: SOC should be culturally competent, with the agencies, programs, and services that are responsive to thecultural,linguistic,racial,andethicaldifferencesofthepopulationstheyserve.

Core Value: SOC should be child, family, person-centered and family and community focused, with the needs of the child or individual and family dictatingthetypesandmixofservices provided.

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History of SOC — Key Events Nationally and in GeorgiaThe impetus for the SOC concept can be traced back to a 1982 study, which found that approximately 66% of children with serious emotional disturbance were not getting proper services due to a lack of coordination among child-serving agencies (Children’s Mental Health Network, 2017). In response, the National Institute of Mental Health (NIMH) began the Child and Adolescent Service System Program (CASSP) in order to help states, through funding and technical assistance, better coordinate multiple state agency services for SED children. Two years later,CongressappropriatedthefirstCASSPfundsforaselectnumberofstates,andGeorgia was one of 10 initial states chosen. At the same time, Georgia’s Southeastern Regional Troubled Children CommitteewasawardedoneofthefirstlocalSOCdevelopmentgrants.In1986,Congresspassedthe State Comprehensive Mental Health Services Plan Act to cultivate coordinated community-based mentalhealthservices,andtheterm“SystemofCare”wasdefined.In1992,theSubstanceAbuseMental Health Services Administration (SAMHSA) and Children’s Mental Health Initiative (CMHI — aimed at strengthening community-based services and supports for children and their families) were created by the federal government, and the SOC family-centered, community-based, coordinated approach to service delivery for children with SED spanned the entire nation, with CASSP grants in every state and CMHI funding to develop and implement SOCs in over 170 communities, tribal regions, or states (Children’s Mental Health Network, 2017). By 2009, the federal CMHI budget had grown to $114 million.

From 1984 to the present, Georgia has made numerous investments in order to develop its SOC. These key investments and other important events have been outlined in Figure 2.

Figure 2. Georgia SOC: Key Events and Investments 1984-2016

1984

1987 -1988

1989

1990

1992

1993

1999

GeorgiareceivesSAMHSACASSPgrant.1986SoutheasternRegionalTroubledChildrenCommitteereceives SAMHSA local SOC grant.

Georgia receives federal children and adolescent mental health (CAMH) Capacity Building grant and developsSEDcapacitybuildingplanforexpansionofcommunity-basedservices.

BasedonCapacityBuildingPlan,Georgia Department of Human Resources, Division of Mental Health, Mental Retardation, and Substance Abuse(DMHMRSA) securesinitialseparatefundingforexpansionofCAMHthroughlegislativeappropriation.GeorgiaParentSupportNetworkInc.,Georgia’sFederationofFamiliesforChildren’sMentalHealthchapter, founded.O.C.G.A.§§49-5-220–226callsonDepartmentofEducation(DOE)andDepartmentofHuman Resources (DHR)tocraftafive-yearSOCStatePlanandofficiallyestablisheslocalinteragency committees.

SAMHSA requires all states receiving mental health block grant funds to develop a separate children’s plan addressing an organized, comprehensive, community-based SOC.

SAMHSA requires all states receiving mental health block grant funds to spend no less than 10% to supporttheimplementationofthechildren’smentalhealthplan.DHR/DMHMRSAusesthesefundsandstatefundstocontinuetosupportfundingoftheCapacityBuildingPlan.

DHR/DMHDDAD completes Phase I of the Capacity Building Plan, garnering over $35 million for child and adolescent mental health services.U.S. Supreme Court delivers Olmstead v. L.C. decision.

SAMHSA grant awarded to Rockdale and Gwinnett counties to create SOC collaboratives called Peachstate Wraparound Initiative (PSWI), eventually renamed KidsNet.Georgia receives SAMHSA Child and Adolescent State Infrastructure Grant (CASIG) funding. KidsNet Georgia becomes statewide SOC collaborative.

2000

2004

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2005

2006

2009

2010

2011

2012

2013

2014

2015

DBHDD gets SAMHSA Substance Abuse Coordination (SAC) grant to develop and implementstrategiesto expand SOC approaches to service delivery for substance use disorders (SUDs)among children.

GeorgiareceivesCentersforMedicareandMedicaidServices(CMS)AlternativestoPsychiatricResidentialTreatmentFacilities(PRTF)DemonstrationgrantandSAMHSAgrantstocreateCommunityBasedAlternativesforYouth(CBAY)programandWraparoundInitiativeNorthwestGeorgia(WINGA).

First state-sponsored annual SOC Academy is held.

GeorgiaDOEreceivesPositiveBehavioralInterventionsandSupports(PBIS)grant.

GeorgiaDepartmentofBehavioralHealthandDevelopmentalDisabilities(DBHDD)iscreated.O.C.G.A.§37-2-4createsBehavioralHealthCoordinatingCouncil(BHCC).

DBHDDgetsCMSChildren’sHealthInsuranceProgramReauthorizationActof2009(CHIPRA)and SAMHSA HealthyTransitionsgrants.

TheDepartmentofJusticesuesGeorgia(citingOlmstead) for lack of community-based services (settlementagreementisreachedin2010).

InteragencyDirectorsTeam(IDT)isfoundedfromKidsNetGeorgiastatewideSOCcollaborative. Governor’sOfficeofChildrenandFamiliesiscreated.

DBHDDcreatesupdateddraftfive-yearstateSOCplan;planguidesIDT.

GeorgiaCenterofExcellenceforChildren’sBehavioralHealth(COE)isfounded.

DBHDD establishes Resiliency Support Clubhouse Program.

HB242reformsjuvenilejusticecodewithlargefocusoncommunityalternativestodetentionandChildren in Need of Services (CHINS).

IDTcreatesGeorgiaCAMHsystemsmaps;TheCentersforDiseaseControlandPrevention(CDC)joinsIDTasconsultant;IDTworksonattention-deficit/hyperactivitydisorder(ADHD)services.

DBHDDreceivesSAMHSASOCExpansionandImplementationCooperativeAgreementGranttocreatesustainable SOC infrastructure in the state and designates IDT as the grant’s advisory body.

Georgia DOE hosts PBIS Summit.

DOEreceivesProjectAWARE(AdvancingWellnessandResilienceinEducation)grant.

Department of Public Health (DPH) receives Project LAUNCH grant in partnership with DBHDD.

FostercareyouthtransitiontoMedicaidmanagedcare.

DBHDDandDepartmentofJuvenileJustice(DJJ)initiatejointHighFidelityWraparoundpilotforSEDyouth in custody.

IDT creates CHINS reference sheets for judges.

Statechild-servingagenciessignIDTmemorandumofunderstanding(MOU).IDTdraftsOperationalGuidelines.

DBHDDinitiatesstatewide,school-basedmentalhealthpilot.

Legislaturepassesschoolsuicidepreventiontraining;SenateinitiatesstudycommitteesonbehavioralhealthandSUDs;Housecreatesschool-basedhealthstudycommittee.

Division of Family and Children Services (DFCS) initiates state blueprint for change for child welfare.

DOJ publishes findings and remediation requirements for DOE regarding Georgia Network for Educational and Therapeutic Support (GNETS).

Department of Community Health (DCH) Medicaid works to further telehealth and telepsychiatry. DFCS

implements Family First Prevention Services Act.

Multiple juvenile justice code rewrite initiatives continue to work on implementation.

DBHDD transitions school-based mental health pilot to program.

2016


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Why Does Georgia Need a SOC Plan Now?Overthelast30yearsGeorgiahasmadesignificantinvestmentsthroughgrants,agencypolicies,legislation, and other initiatives to develop its SOC, including two prior draft state SOC plans (illustrated in the previous timeline, Figure 2, pp. 11).Withinthepastfivetosixyearsinparticular,Georgia has seen an expanded focus on activities, programs, and funding aimed at improving children’s mental health, supporting the SOC philosophy in various ways. Thus it is crucial that at this moment, with such a large amount of activity and investment, a new SOC plan be created in order to help coordinate and enable the best outcomes from all of these moving parts.

Georgia is at a critical juncture with its SOC and in meeting the behavioral health needs of its children and young adults. At the end of 2015 there were four study committees of the Georgia General Assembly committed to children and child services. Georgia has had great success in agency collaboration with Project LAUNCH, Project AWARE, and the Cooperative Agreements for Expansion and Sustainability of the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances Grant, and our SOC initiatives continue to grow. To facilitate implementation, the 2017 Georgia SOC State Plan will include a detailed implementation plan with a schedule of deliverables, accountability, and an evaluation plan to measure its outcomes. As a workgroupoftheBHCC,consistingoftheexpertsinthefield,theIDTisuniquelydesignedandqualifiedtocraftaSOCplanthatwillfurtherguidetheworkofbothgroupsandstrengthenGeorgia’s SOC efforts over the next several years. Given the interest in children’s behavioral health from both our state and national partners, and Georgia’s proven success, the time is now to create a SOC state plan, and the IDT is the group to best do it. The last SOC draft plan was created in 2010 andwasnotfullyimplemented;anew2017GeorgiaSOCStatePlanisneededinordertoreflectthemost recent updates to national SOC philosophy and teachings, the Georgia CAMH system and available services, and current needs of children with SED in the state.

Scope of the SOC State PlanThe 2017 Georgia SOC State Plan focuses on children, adolescents, and emerging adults (ages 4-26) withSED.SEDisdefinedas:

Diagnosablemental,behavioral,oremotionaldisorderofsufficientdurationtomeetdiagnosticcriteriaspecifiedwithinDSM-[V]thatresultedinfunctionalimpairment,whichsubstantially interferes with or limits the child’s role or functioning in family, school, or community activities (Federal Register, 1993).

Thisdefinitiononlyincludessubstanceuseordevelopmentaldisorderswhentheyco-occurwithanotherdiagnosableSED.Further,functionalimpairmentisdefinedas:

Difficultiesthatsubstantiallyinterferewithorlimitachildoradolescentfromachievingor maintaining one or more developmentally-appropriate social, behavioral, cognitive, communicative, or adaptive skills. Functional impairments of episodic, recurrent, and continuous duration are included unless they are temporary and expected responses to stressful events in their environment. Children who would have met functional impairmentcriteriaduringthereferencedyearwithoutthebenefitoftreatmentorothersupportservicesareincludedinthisdefinition(Federal Register, 1993).

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InGeorgia,duringstatefiscalyear(SFY)2014: ¾ State agencies served an estimated 100,3951 children, adolescents, and emerging adults

with SED. ¾ The most prevalent diagnoses of children served included ADHD, posttraumatic stress

disorder (PTSD), bipolar disorder, anxiety disorder, and depressive disorder. ¾ Five primary state agencies provided services or supports to these children, adolescents,

and emerging adults with SED: DCH (50,423), DBHDD (28,377), DOE (12,912), DJJ (5,683),and DFCS (3,000).

¾ The state spent an estimated $263,976,378 of state funds on SED services and supports. ¾ A grand total of $442,300,971 (state and federal funds combined) was spent on children,

adolescents, and emerging adults with SED, equaling an estimated $4,405.61 per child.

Children, adolescents, and emerging adults with SED are the focus of the 2017 Georgia SOC State Plan, as they are a prevalent, vulnerable population that requires a SOC approach to service and support delivery to truly function and thrive. Services and supports for children with SED and their families have historically been fragmented and lacked coordination (CMHN, 2017). Moreover, when services and supports are delivered in a manner that is not in line with SOC core values or guiding principles (highly coordinated, community-based, family- and child-focused), children, adolescents, and emerging adults with SED, due to their vulnerability, are at an increased likelihood of facing diminished functioning, with negative, recurrent, and more costly systems interactions over the course of their lives. In particular, children, adolescents, and emerging adults with SED are more likely to experience:

¾ SUD or other co-occurring disorders (Perou et al., 2013); ¾ Initial and repetitive juvenile and criminal justice system interaction (Hammond, 2007); ¾ Lower academic functioning and higher dropout rates (National Association of School

Psychologists, 2012); ¾ Chronic health conditions, emergency department visits, and in-patient hospital stays

(Perou et al., 2013); or ¾ Suicide ideation, suicide attempts, or suicide (Perou et al., 2013).

The following CAMH systems map, created by IDT in 2013 (Figure 3), illustrates how a child with SED can fall off track from functioning at any time, and if they are not provided with the right servicesandsupports,canremainofftrackandsuffernumerousdifficultiesthroughadulthood.A SOC approach to service and support delivery seeks to ensure that children with SED and their families receive what they need to stay on, or get back on, track.

1 Thisfiguremayincludeduplicatecountsofchildrenwhoexperiencedmultipleagencycontactsin2014.


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Figure 3. IDT Systems Map — Child Development On- and Off-Track

It is undeniable that preventive care (particularly in early childhood) is extremely important in starting children on track to identify and inhibit (where possible) the development of SED in a child. However, because of the pressing need for coordinated and appropriate service delivery for children (ages 4-26) currently diagnosed with SED, which is the basis of the SOC concept, the three-year 2017 Georgia SOC State Plan focuses on aligning Georgia’s resources in order to create a targeted SOC approach to help those children remain or be returned back on track. In future years, it is possible that an updated Georgia SOC State Plan could be expanded to include broader preventive services and supports for children not yet diagnosed with SED.

Roles of the IDT and BHCCIn 2011, DBHDD created the IDT as the working group of the BHCC, devoted to developing and maintaining Georgia’s SOC for children and youth with SEDs. The IDT helps promote and realize the initiatives of the BHCC, and the BHCC provides high-level support and guidance to the IDT.

The IDT, as the state’s multiagency SOC leadership collaborative, whose mission it is to manage, design, facilitate, and implement the CAMH SOC in Georgia, has led the development of the 2017 Georgia SOC State Plan. IDT is a working group of the BHCC21and is composed of director-level members from all child-serving agencies in Georgia, as well as a number of partner organizations representing youth, family, and providers. IDT has been in operation since 2011 (and prior to that in the form of the KidsNet Georgia state collaborative since 2004). IDT state agency members include DBHDD, DOE, Georgia Vocational Rehabilitation Agency (GVRA), the Department of Early Care and

2 The BHCC was created by O.C.G.A. § 37-2-4 to identify and ensure the coordination of overlapping behavioralhealth services, funding, and policy within the state and between state agencies. The BHCC is led by the commissioner of DBHDD and is composed of commissioners from each relevant state agency, as well as legislators, consumers, consumer family members, and state ombudsman.

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Learning (DECAL), DCH, DFCS, DJJ, and DPH. Provider groups, care management organizations, and family and child advocacy organizations serve as partner agencies, and the CDC as a federal consultant. For a full list please see the Acknowledgements section.

From its inception, the IDT was created to further develop Georgia’s SOC for children, adolescents, and emerging adults, and serves as the multiagency oversight body for Georgia’s System of Care Expansion Implementation grant for children and youth with SED. Over the past few years, IDT has gained momentum in its ability to successfully coordinate between agencies and take on particular children’s mental health challenges for the state. Given its member composition, SOC mission, expertise, and track record of success, IDT was the natural body to take the lead on developing the Georgia SOC State Plan. The IDT will create and modify the plan with high-level guidance, review, and input from the BHCC.

Plan Development, Methods, and StructureHow Was the SOC Plan Created?Over 15 months (March 2016–May 2017), under direction from the BHCC, the IDT developed the 2017 Georgia SOC State Plan. Georgia has developed SOC plans in the past, and, as documented previously, possesses a great deal of expertise and experience in SOC work. In addition to local expertise, the IDT enlisted the help of the National Training and Technical Assistance Center for Children’s Behavioral Health (TA Network). The TA Network is a partnership of 13 organizations with expertise in SOCs for children, led by the Institution for Innovation and Implementation at the University of Maryland, School of Social Work. The TA Network provides training and technical assistance to SAMHSA SOC grantees and other state and local agencies seeking to improve children’s behavioral health care. Through funding from the SAMHSA’s Child, Adolescent and Family branch, the TA Network was able to provide support to the process in the form of:

• Process guidance;• Regularly scheduled and ad hoc phone and email contact and support;• Document review and feedback;• Two-day on-site group facilitation (July 2016); and• Direct mentorship and provision of expertise to COE staff to collaboratively produce draft

documents.

TheworkbeganinMarch2016whenaworkgroup,specifictoSOCstateplancreation,convenedand began to explore consultants and to devise the plan process. By May 2016, the TA Network had agreed to assist in plan creation by providing the supports listed above.

With support from the TA Network, the COE solicited and gathered historical SOC documents from Georgia. A matrix was created with descriptions and recommendations for each report. Additionally, the COE collected SOC state plans from Connecticut, Nebraska, Maryland, and Vermont, and created a matrix of methods, summaries, and focus areas. These materials were shared with the SOC workgroup prior to their July 2016 meeting to inform the discussion and ensure that historical work and documents were built upon, rather than duplicated. Two representatives from the TA Network facilitatedaworkgroupmeetingJuly11–July12,2016.Duringthismeeting,theIDTidentifiedthefivefocusareasofthisplan:Access,Coordination,WorkforceDevelopment,FundingandFinancing,and Evaluation. On the second day, then-DBHDD Chief of Staff Judy Fitzgerald spoke to the group, supporting the work of the plan and providing high-level guidance.


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Over the course of the two days, the workgroup:• Completed an environmental scan to ground and contextualize the work;• Determined broad goals and needs to be met by the plan;• Agreed upon a scope and timeframe for the plan;• Utilized historical Georgia documents to identify focus areas;• Createdandrefinedgoalstatementsforeachofthechosenfocusareas;• Identifiedagency-specificoutcomemeasures;and• Created both short-term (one-year) and long-term (two- to three-year) objectives for each

focus areas.

The COE then synthesized this information, which was presented to the larger IDT for input and feedback at the November 2016 meeting. After this input was integrated by the COE, the information and work was presented to the BHCC in December 2016 in the form of a PowerPoint presentation. The BHCC granted its permission and support in moving forward. Again, the COE and IDT consulted with the TA Network for guidance, and it was decided to utilize the IDT meetings as workingmeetingstocreateafullyfleshed-outdraftforpresentationtotheBHCCinMay2017.TheCOE facilitated and supported the IDT meetings as the group formed workgroups around the following focus areas: Access, Coordination, Workforce Development, and Funding and Financing. Foreacharea,workgroupsidentifiedbothshort-andlong-termActionItems.Thesewereintegratedinto the sections that you will see below. After vetting from the entire IDT, the group created the Implementation Plan and Summary Table.

IDT and Larger Stakeholder InputAfter feedback and input from the BHCC, the IDT plans to engage the broader stakeholder community. Feedback will be solicited via an online form on the IDT webpage, where the plan will be made public. Additionally, IDT will plan and host focus groups for children, youth, and families to solicit real-time feedback for later incorporation.

Plan StructureTheGeorgiaSOCStatePlanisbuiltaroundthefollowingfiveareasoffocus:

• Access;• Coordination;• Workforce Development;• Funding and Finance; and• Evaluation.

Duringthetwo-dayin-personmeeting,facilitatedbytheTANetwork,thegroupidentifiedtheseareas as the most salient and in need of attention. Additionally, the IDT created the following conceptual framework, integrating the focus areas and providing clarity to their relationships. Access and Coordination were deemed the most critical areas of focus. Workforce Development and Funding and Financing strategies can be conceptualized as methods through which to increase Coordination and Access. As a focus area, Evaluation wraps around the entire plan and feeds back into future planning efforts.

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Figure 4: SOC State Plan Conceptual Framework

For each of the focus areas, the SOC State Plan workgroup created goal statements. Utilizing previous Georgia documents, goal statements were updated and revised by the group. They then created both long-term and short-term strategies for each area. The next section details the focus areas, providesjustificationandrationaleforwhytheywerechosen,andpresentsandexplainstheActionItems for each, chosen by the group, and how they hope to achieve the goals.


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Focus Area 1: Access

Goal statement: Provide access to a family-driven, youth-guided, culturally competent and trauma-informed comprehensive System of Care to meet the needs of children, youth, and young adults with severe emotional disturbance (SED), substance use disorders, and co-occurring disorders.

Short-term Strategies Long-term Strategies1.1 Service mapping for behavioral health

service utilization1.5

1.61.2 Increase behavioral health services available in schools

1.3 Improve families’ abilities to navigate the current system

1.7

1.4 Increase utilization of Intensive Care Coordination (IC-3) services

1.8

Utilize data to inform a strategic approach to access

Recruit practitioners in shortage areas

Support continuity of care by addressing continuity of eligibility for Medicaid (address children and youth going on and off the Medicaid roll)Strategically increase the use of telemedicine/telehealth services within child-serving agencies

Access to an array of community-based services and supports is a core component of any functional behavioral health care system. For children and emerging adults, access to mental health services iscriticallyimportantforearlyidentificationofmentalhealthconcernsandlinkagetoappropriateservices.OneinfivechildrenintheUnitedStateshasadiagnosablementalhealthdisorder,butonly21% of those children needing mental health services receive care (American Academy of Pediatrics, 2017). Lack of care can be due to multiple factors, including cost, stigma, and a lack of available services, particularly in rural areas. In Georgia, approximately 19% of children live in rural areas (Georgia’s Online Analytical Statistical Information System, 2015), where access to medical, dental, and mental health care services is impaired by an inadequate provider base, long distances to clinics, and less insurance coverage for rural Georgians (Georgia DCH, 2015). In particular, there is a lack of rural mental health care providers of services for children in Georgia (Knopf, 2013). A recent report noted that there were 185 practicing child and adolescent psychiatrists in Georgia. Given the population of children in Georgia, this equates to approximately seven child and adolescent psychiatrists per 100,000 children (American Association of Child and Adolescent Psychiatry, 2015). In this report, 123 (77%) of the 159 counties in Georgia did not have a practicing child and adolescent psychiatrist (American Association of Child and Adolescent Psychiatry, 2015). Behavioral health provider shortages impair access to timely mental health services for children. As we know that behavioral health issues can impact a child’s and family’s well-being, academic progress, and future productivity, as well as the problems we see in the education, juvenile justice, and child welfare systems, this lack of care must be addressed. A focus on access was chosen to support children and families in their access to and navigation of mental health care services in Georgia, a persistent challenge in the current system. The group arrived at the following short- and long-term strategies to address this challenge.


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Short-term Strategies

To strategically reduce barriers to accessing services, it is important to obtain data on behavioral healthserviceutilizationandthespecificcountiesandserviceareaswhereaccessisheavilyimpaired. We must know what we have before we can determine what we need. This data-driven approach will allow for targeted service expansion and provider recruitment in areas with greater barriers to service access.

Action Item 1.1.1 Utilize the following data sources: DCH/DBHDD and Voices, MH professional shortage areas; analyze by service area and county; identify proxies for key indicators to track and share

Action Item 1.1.2 Create a centralized location for data sources

There is no clear repository for data on available services, particularly those that serve Medicaid and care management organization (CMO)-covered lives, state-contracted services, and private practitioners who accept only private insurance or self-pay clients. Much of this data exists and will need to be synthesized and interpreted to be effectively utilized to discover gaps and opportunities to strengthen the system and improve access for children and families.

Strategy 1.2 Increase behavioral health services available in schools

School-based mental health (SBMH) programs promote access to mental health services, increase earlyidentificationofmentalhealthneeds,andprovideinterventionsforchildreninneedofbehavioral health services. Based in the school setting, these programs provide a continuum of behavioral health care to students and their families. Further, such programs foster collaboration between school systems, mental health providers, and other community stakeholders (Georgia Health Policy Center, 2015).

Framework for School-Based Mental Health Services

Although there are a variety of frameworks that guide SBMH programs, one of the most common is a three-tiered conceptual model (Colorado Department of Education, 2007; Costello-Wells, Ladrienne, Reed, & Walton, 2003; Fox et al., 1999). Under this design, the provision tiers of school-based mental health services can be viewed as a triangle with three distinct levels (Figure 5). At the base of the triangle lies Tier 1: Universal Prevention. Tier 1 services are geared toward the entire school population (i.e., schoolwide programs that promote positive behavior, such as Positive BehaviorInterventionandSupports[PBIS]orMentalHealthFirstAidprograms).Approximately85% to 90% of students have their needs met in this tier, with the ultimate goal of preventing the need for more intensive interventions. As services in Tier 1 are generalizable to an entire

Strategy 1.1 Service mapping for behavioral health service utilization

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school, providers of Tier 1 services include all school staff members. Above Tier 1 lies Tier 2: Early Interventions. Services in Tier 2 are geared toward a subset of students in a school who are at risk for developing mental health concerns (e.g., social skills trainings and short-term counseling). Approximately 7% to 10% of students have their needs met in this tier. Because services in Tier 2 target at-risk students, providers of these services are more specialized, such as school counselors, social workers, or mental health providers. Finally, at the top of the triangle lies Tier 3: Intensive Interventions. Services in Tier 3 are tailored to high-risk students and are highly individualized (e.g., personalized, function-based behavior intervention plans and long-term counseling). Approximately 3% to 5% of students require supports in this tier. Because of the increased intensity of services provided in Tier 3, providers of these services are generally school mental health providers (Colorado Department of Education, 2007; Costello-Wells, Ladrienne, Reed, & Walton, 2003; Fox et al., 1999).

Figure 5. Three-Tiered Approach to School-Based Mental Health

Source: Miles, J., Espiritu, R., Horen, N., Sebian, J., & Waetzig, E. (2010). A Public Health Approach to Children’ Mental Health: A conceptual framework. Washington, D.C.: Georgetown University Center for Children and Human Development, National Technical Assistance Center for Children’s Mental Health.

In recent years, several initiatives have launched in Georgia that utilize behavioral health services in schools as an approach to reducing barriers to access. The Georgia Apex Project, supported by DBHDD, is focused on building infrastructure and increasing access to mental health services for school-aged youth throughout the state. The Apex Project, which began in school year 2015-16, recognizesthatschoolsareanaturalenvironmentforidentificationandinterventionandaimstoreduce the number of youth with unmet mental health needs, and supports community mental health providers to partner with schools and provide school-based mental health services. In addition, the program increases coordination between local schools and the state’s community behavioralhealthsystem.Alsosituatedinschools,ProjectAWAREisafive-yearSAMHSAgrantthatwas awarded to the Georgia DOE in September 2014. Project AWARE, currently implemented in threeschooldistricts,providestraininginyouthmentalhealthfirstaidandfocusesondevelopingprocesses and procedures for connecting youth and families to community-based mental health services. These programs, as well as others in Georgia, are a valuable resource for increasing behavioral health services in schools. The DOE has also worked in current years to expand implementation of Positive Behavioral Intervention and Supports (PBIS) programs to districts and schools throughout the state.

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Action Item 1.2.1 Establish a baseline measure of schools that self-identify as having access to all three tiers of school-based mental health services

Action Item 1.2.2 Increase the number of schools with access to all three tiers of school-based mental health services

Action Item 1.2.3 Increase the number of students receiving services in the school setting

Child-serving agencies will continue to coordinate school-based services to increase access and reducebarriersforchildrenandtheirfamilies.Again,theIDTwillfirstmeasurewhatexistsinorderto expose gaps and opportunities to strategically support the continued expansion of all three tiers of SBMH services throughout the state. This information can provide guidance for future program and strategic interventions.

Strategy 1.3 Improve families’ abilities to navigate the current system

Understanding the types of services and supports offered, where to receive them, the continuum of care when transferring between child-serving systems, how to navigate this system, and other processes of behavioral health care can be a challenging and complex task. For many parents and youth, this serves as a barrier to accessing services. Creating resources to help families navigate the system could enhance the ability of youth and their families to access services in Georgia.

Action Item 1.3.1 Create resource tools for families and youth

Action Item 1.3.2 Create an orientation to services for families and youth for each IDT member agency

Action Item 1.3.3 Create resources for youth ages 18-26 to assist with self-navigation of services

Mentalhealthservicesforchildrenandyouthcanbefragmentedanddifficulttoaccess,creatingdelays in care and unmet needs. As the Georgia SOC continues to evolve and become more cohesive, agencyservicescanremaininsilosthataredifficulttonavigate.Asafirststep,short-termactionitems pertain to the creation and dissemination of resource materials for youth and families to help innavigatingwhatcanbeacomplexanddifficultsystem.

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Strategy 1.4 Increase utilization of Intensive Care Coordination (IC-3) services

The SOC approach holds at its center the principle of keeping youth and families together, in their own home, with appropriate services and supports.

Beginning in 2006, the state was awarded a grant for the CMS PRTF demonstration waiver. As a part of the grant, the state Medicaid and behavioral health authorities collaborated on implementing High Fidelity Wraparound services. Subsequently, the state was required to submit a 1915 C waiver applicationtoCMS,whichcreatedtheCBAYwaiverasthemechanismforimplementingthegrant.Asmall subset of providers were trained in the High Fidelity Wraparound (HFW) model and worked withnationalfidelityexpertstoimplementandrefinetheservice-deliverymodel.Atthetermination of the grant the state was charged with a sustainability plan that included multiple funding mechanisms to continue the HFW model. Given that the fund sources also have variable termination dates, the state has chosen to rename that service as Intensive Customized Care Coordination (IC3) and will implement that service in summer 2017 as a part of the state’s Medicaid plan. Because the original grant was targeted to a limited number of individuals, it is expected that the state plan will cover a larger number of covered youth eligible to receive the service.

For Medicaid providers to receive reimbursement for these services, it is essential that they have an understanding of these services and authorizations. Thus, trainings on this service model are critical to implementation.

Action Item 1.4.1 Add this service to the Medicaid State Plan

Action Item 1.4.2 Produce baseline utilization data for year 2016 to create a benchmark

Action Item 1.4.3 Train providers on this service model

Action Item 1.4.4 Performquality-assuranceactivitiestoensurefidelity;usedatafordecision-making in place

NotonlyshouldprovidershaveaclearandthoroughunderstandingoftheIC3servicecodes,fidelityto the Wraparound model should still be monitored. Data can then be utilized to inform future training and implementation efforts.


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Long-term Strategies

Utilizing data for dissemination, recommendations, and monitoring of access-related action items is crucial to ensuring strategic and data-driven systems change (Preskill, Parkhurst, & Juster, 2014). Data gathered in strategy 1.1 will be evaluated, analyzed, and incorporated into efforts that inform programmatic improvement and support the increase of children’s access to behavioral health services.

Action Item 1.5.1 Compile data from strategy 1.1 and create a communication and dissemination plan

Action Item 1.5.2 Shareinformationwithkeystakeholdersthatcaninfluencetheaccessprocess (purchasing authorities and state agencies)

Action Item 1.5.3 Utilize data to develop recommendations for improved care

A central repository for data will be key in coordinating data-sharing and integration. Georgia agencies do not currently have a shared data repository and very few shared measures. To better coordinate agency funding and services, data about child and youth behavioral health providers, education, and juvenile justice efforts should be compiled, analyzed, and then utilized to identify opportunities for system improvement.

Strategy 1.6 Recruit practitioners in shortage areas

The behavioral health workforce has faced shortages for decades, contributing to problems with access. This is particularly salient in rural areas. It is estimated that in Georgia, there are about 11 psychiatrists per 100,000 people, and only about six child and adolescent psychiatrists per 100,000 youth — ratios that are below national averages (Walker et al., 2015). These workforce shortages are felt even more acutely in rural areas, where children and families are even less likely to have access to a provider (New Freedom Commission on Mental Health, 2003). Targeted interventions to recruit and incentivize providers in shortage areas aim to reduce disparities in access.

Strategy 1.5 Utilize data to inform a strategic approach to access

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Action Item 1.6.1 Research shortage area plan from other states and Georgia

Action Item 1.6.2 Work with schools of social work, psychology, etc. to identify incen-tives and ensure training programs address the needs of youth and families in shortage areas

Action Item 1.6.3 Increase the number of peer specialists for parents and youth throughout the state

The IDT prioritizes the three approaches above and will present them to the BHCC as a potential budget request that state agencies can support. A number of strategies have been employed nationally, by other states, and in state by the DPH in attempts to address the workforce shortage. The IDT will examine previous efforts and identify strategies that could work in Georgia.

DBHDD is currently working with the University of Georgia’s School of Social Work to ensure that training systems are responsive to the needs of the state in terms of public-sector workforce. This partnership may be expanded and used as a model for implementing similar partnerships that promote the training and recruitment of mental health service providers to strengthen the workforce that serves children in Georgia.

GeorgiaisaleaderinCertifiedPeerSpecialistServices.In2017,YouthandParentPeerSupportservices were added to the Georgia Medicaid State Plan. An important component in recovery and adjunct to the care team, peer support services can ameliorate some of the provider shortages throughout the state, and the IDT sees value in continuing to increase the number of available supports.

Strategy 1.7 Support continuity of care by addressing continuity of eligibility for Medicaid (address children and youth going on and off the Medicaid rolls)

In 2016, Georgia had three CMOs, by far the largest segment of children. Each CMO has its own contract with the state that may cover slightly different things and require authorizations for some services. Agency directors and local provider stakeholder groups came to notice that children often lost coverage when premiums were not paid and that children went on and off the rolls often. This created an access issue, as the providers had to check coverage status each time a service was provided. It also left some providers unable to collect payment if the child was in a coverage gap. To ensure continuity of care, it is critical that children maintain coverage without jumping on and off the Medicaid and CMO rolls.

Action Item 1.7.1 Provide more resources for training, navigation, and paid eligibility workers in social service agencies

Action Item 1.7.2 Provide support and education about eligibility for youth aging out of foster care

Action Item 1.7.3 Create baseline data; evaluate improvement annually


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The IDT sees this as an issue of education and misunderstanding. Through an analysis of Medicaid eligibility policies and training to various stakeholders, the group hopes to address this issue. A more clear understanding on the provider side could also contribute to a decrease in service provision for uncovered children.

Strategy 1.8 Strategically increase the use of telemedicine/telehealth services

within child-serving agencies

In addition to strategy 1.6, telemedicine technology exists as an opportune vehicle to increase provider capacity and reach, particularly to rural areas. Telemedicine for behavioral health services stands as one possible solution to the problem of limited mental health care access in rural Georgia (Knopf, 2013). Telemedicine for behavioral health is the delivery of mental health services via electronic means, usually videoconferencing (American Telemedicine Association, 2013). In 2016, according to the Georgia Partnership for Telehealth, there were 45 partner locations in Georgia that offered behavioral health services through telemedicine (Georgia Partnership for Telehealth, 2016). In addition, Georgia’s DPH currently has telecommunication capacity in 157 out of 159 counties andisactivelyengagedindevelopinganetworkoftelemedicine-capableclinicsandoffices(GeorgiaDepartment of Public Health, 2016). In regard to children, school-based health centers (SBHCs) are an increasingly common site for the provision of mental health services, and comprehensive SBHCs include both a primary care and behavioral health provider on-site (School-Based Health Alliance, 2014). Currently, there are 22 comprehensive SBHCs operating in Georgia (Georgia School-Based Health Alliance, 2016). Nationally, utilization of telemedicine technology is low in SBHCs (7.3%) but somewhat higher in rural areas (12.7%; School-Based Health Alliance, 2014). Broadly, Georgia has many of the necessary policies in place to support behavioral health services delivered through telemedicine as a strategy for increasing children’s behavioral health service access, particularly in rural areas.

Action Item 1.8.1 Service mapping of behavioral health services provided through telemedicine(subsetof1.1usingaGTbillingmodifier)

Action Item 1.8.2 Current status scan on public payer policy on the use of telemedicine

Action Item 1.8.3 Mapping of where telemedicine facilities are located for behavioral health services

Understanding the current utilization of telemedicine for behavioral health services will allow a baseline measurement for determining where and how much to increase the use of these services. Additionally, understanding the current public payer policy on the use of telemedicine will allow for the closure of gaps in service continuity. An understanding of where these services are offered will allow for the strategic placement of additional resources for telemedicine in areas that are underserved in terms of children’s behavioral health services.

Access to an array of appropriate services is a struggle for any system but undeniably key in meeting the needs of children and youth with SEDs and their families. The IDT hopes that the above strategies will increase access across the state.

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Focus Area 2: Coordination

Goal statement: Facilitate effective communication, coordination, education, and training within the larger System of Care and among local, regional, and state child-serving systems.

Short-term Strategies Long-term Strategies2.1 Build and maintain feedback loops

between local, regional, and state agencies and systems

2.3 Create and utilize a common language (as it relates to discussing SOC principles and making the business case to internal and external stakeholders)

2.4 Address gaps in the crisis continuum by adding additional levels of care that will address capacity and acuity concerns: Crisis Respite; IC3; therapeutic foster homes

2.2 Increase training on SOC for all stakeholders

At the heart of the SOC approach are coordination and collaboration between child-serving agencies and organizations, and between the child, family, and larger system. The IDT serves as the multiagency leadership collaborative that strives for an integrated and coordinated approach to serving children in the community. Not only is coordination between child-serving agencies conducivetoaneffectiveandefficientsystem,coordinatedandcommunicationsystemsbetweenlocal, county, regional, and state bodies are a vital feedback loop to ensure that local and regional needs and resources are understood, and state and county-level policy objectives are being achieved. This area of focus was chosen as an integral part of a coordinated network that serves children and families.


Strategy 2.1 Build and maintain feedback loops between local, regional, and state agencies and systems

Georgia’s system is designed with local, regional, and state-level SOC infrastructures that complement and support each other. Local Interagency Planning Teams (LIPTs), required by Georgia Code § 49-5-220-227, were established at the local level to improve and coordinate services for children and youth with SEDs. LIPTs often exist at the county or multicounty level, and some are more active than others. Their main charge is to ensure that children and youth receive necessary and coordinated services in the community. In 2009, DBHDD created Regional Interagency Action Teams (RIATs) in each of DBHDD’s six service regions to support the work of the LIPTs. LIPT chairs in each of the DBHDD regions formed the makeup of RIATs. Meetings were held quarterly to identify


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challenges and barriers to service delivery at the regional level. RIATs were also able to identify training needs, share successes and challenges, and plan for services throughout the region. Some RIATsdiscontinuedmeetingafewyearsago,andcurrentlysomeLIPTsaremoreactiveandefficientthan others. One of the reasons for this variability has been the lack of a legislative or formal mandatefortheRIATsaswellasapointofaccountabilityidentifiedatthestatelevelorcapacityneeded to support continued operations of these bodies. The IDT recommends reconstituting the RIATs, an important link missing from Georgia’s SOC infrastructure.

PerGeorgiaCode§37-2-4,Georgia’sBHCCwascreatedin2010to“toidentifyoverlappingservicesregarding funding and policy issues in the behavioral health system.” The BHCC is a commissioner-level collaborative that supports behavioral health services throughout the state. The BHCC is chaired by the commissioner of DBHDD, and members include commissioner- and director-level representatives from each state agency that is impacted by behavioral health, as well as members of the Georgia Legislature, and family and consumer representatives.

In 2011, DBHDD created the IDT as the working group of the BHCC, devoted to developing and maintaining Georgia’s SOC for children and youth with SEDs. The IDT helps promote and realize the initiatives of the BHCC, and the BHCC provides high-level support and guidance to the IDT. State-level support should be provided by the IDT and BHCC to the RIATs and LIPTs; however, without effective feedback loops between these levels of coordination and collaboration, local needs may go unmet. Additionally, state-level initiatives and priorities need to be passed down to the local level for implementation. Georgia has a clear structure for how collaboratives are organized at the local, regional, and state level. A clear communication protocol and active feedback loops are vital to the SOC approach, as is support for the infrastructure of the RIATs and LIPTs.

Figure 6: Feedback Loops

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Action Item 2.1.1 Create and distribute a list of all LIPT chairs to all SOC partners

Action Item 2.1.2 Identify a point person to facilitate organizational structure and communication among and between the LIPTs, RIATs, IDT, and the BHCC

Action Item 2.1.3 Create a communication protocol and template among and between the LIPTs, RIATs, IDT, and the BHCC

As explained above, Georgia has a multilevel infrastructure responsibility for supporting and implementing the SOC approach. As of the creation of this plan there are few formal protocols in place that guide continuous communication between these levels, often leaving a disconnect between state-level policymakers and local communities. A regularly scheduled, formal communicationprotocolcouldensuretimelysharingofinformationfornecessaryfinancialandpolicy supports.

Strategy 2.2 Increase training on SOC principles for all stakeholder groups

Not all stakeholders in children’s behavioral health are aware of what a SOC approach entails, its guidingprinciples,orthebenefitsofsuchanapproach.Trainingandawarenessforallstakeholdersshould contribute to a family-driven, youth-guided, comprehensive SOC for children and youth with SEDs. The ability to speak the same language and utilize an agreed-upon framework could contributetoamoreeffectiveandefficientsystem,withgreaterstakeholderandcommunitybuy-in.

Action Item 2.2.1 DevelopuniformdefinitionofcarecoordinationforCMOsandoperationalize roles for all agencies and stakeholder groups

Action Item 2.2.2 Collect all information/training materials about SOC and care coordination across member organizations

Action Item 2.2.3 Create new or modify existing trainings for LIPTs, LIPT chairs, RIATs, and other groups on the Systems of Care approach

Action Item 2.2.4 Create and disseminate new culturally and linguistically appropriate materials for parents, caretakers, and family members about the SOC approach

Carecoordinationisdefineddifferentlyfordifferentpopulationsandbydifferentcareproviders.Without care coordination, the SOC cannot function collaboratively, and families will face a fragmented system in which children and youth may not receive the support that they need. However, asaservicecode,carecoordinationisnotwell-defined,andagenciesandorganizationsmayhavedifferentunderstandingsofitsdefinition.Aclearandagreed-upondefinitionforbothpracticeandbilling purposes is vital if this service, at the core of a SOC approach, is to be utilized effectively. New, culturally competent materials for providers and for families and caregivers about SOC principles and values could contribute to better service delivery, coordination, and advocacy.


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Strategy 2.3 Create and utilize a common language for discussing SOC principles and making the business case to internal and external stakeholders

The process of creating and accepting an agreed-upon language may also help to shore up support for the SOC approach and expedite the diffusion of SOC principles. This could encourage team and relationship building and coordination among members of different state agencies and partner organizations.

Action Item 2.3.1 Developapocketguide/dictionarytodefineanddescribeSOClanguage

Action Item 2.3.2 Disseminate the guide widely through trainings and conferences, including at the SOC Academy

ItisimportanttouseacommonlanguagetobettercommunicatethebenefitsofSOCtodecision-makersandpolicymakers.The“branding”oftheSOCframeworkisanimportantstepinthedissemination of these principles. The IDT proposes the creation of a pocket guide for SOC principles, describing the language that would be widely distributed at trainings, conferences, and the SOC Academy.

Strategy 2.4 Address gaps in the crisis continuum by adding additional levels of care that will address capacity and acuity concerns: Crisis Respite; IC3; therapeutic foster homes

Without appropriate community supports and appropriate placements, children and youth with SEDscanhavelimitedoptionsforplacement,particularlyduringdifficulttimes.PRTFsarenotappropriate for all youth with SEDs but may be the only option available in the absence of therapeutic foster care or other levels of care in the community.

Action Item 2.4.1 Develop a network of therapeutic foster homes

Action Item 2.4.2 Develop a step-down level of care between that of a Psychiatric Residential Treatment Facility (PRTF) and therapeutic foster home

To service children in the community at an appropriate level of care and address placement issues, Georgia will increase the utilization of IC3 and Wraparound services, and provide an array of appropriate service levels. Therapeutic foster care is an intervention that is a clinical intervention that involves placement in specially trained foster homes for children and youth with SEDs. Placements with these supports could help to prevent unnecessary trips to emergency departments and unnecessary stays in Crisis Stabilization Unit (CSUs) or Psychiatric Residential Treatment Facilities (PRTFs). Additionally, a step-down level of care between PRTFs and therapeutic foster care could prevent re-entry to the PRTF and support a smooth transition back into the community.

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Focus Area 3: Workforce Development

Goal statement: Develop, maintain, and support a culturally competent, trauma-informed workforce to meet the needs of children, youth, and young adults and their families.

Short-term Strategies Long-term Strategies3.1 Targeted expansion of education/

financialincentivestoaddressbehavioral health workforce shortages

3.4 Develop a state mental health workforce plan across IDT agencies with a managed and budgeted scale-up plan

3.2 Develop a clearinghouse of evidence-based/evidence-informed educational materials related to children’s behavioral health

3.3 Explore issues related to scope of practice and workforce shortages

The behavioral health workforce in the United States is inadequate to meet current and growing service demands and behavioral health needs (American Hospital Association, 2016). This is particularlytrueforchildandadolescentneeds.ItisestimatedthatoneinfivechildrenintheUnited States has a diagnosable mental health disorder, but only about 20%of those children needing mental health services receive care (American Academy of Pediatrics, 2017). Workforce issues can be compounded by geographic regions and characteristics, with rural areas at even more risk of experiencing workforce shortages. Well over half of Georgia counties are designated as rural, and an estimated 85% of all federally designated mental health professional shortage areas are in rural areas (Annapolis Coalition on the Behavioral Health Workforce, 2007).

SAMHSA has taken note of the workforce crisis, and the expected impacts of the Mental Health Parity and Addictions Equity Act and the Affordable Care Act in its 2013 strategic plan outlined in its report to Congress (Substance Abuse and Mental Health Services Administration, 2013). SAMHSA reports that high turnover, inadequate compensation, and an aging workforce contribute to shortages. Some of the strategic plans to address these issues focus on educational opportunities and incentives, and funding for specialty services with unmet needs. The Georgia IDThasalsoidentifiedworkforceasamajorbarriertoaccesstocareforchildrenandfamilies,andcreated both short- and long-term strategies aimed at addressing this issue. These strategies, which directly relate to workforce creation and development, also contribute to larger strategies to address access and coordination.


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Strategy 3.1 Targeted expansion of education/financial incentives to address behavioral health workforce shortages

Not only is there a shortage of appropriately trained and licensed providers to meet the needs ofchildrenandfamilies,thoseproviderswhoareappropriatelylicensedmaylackthespecifictrainingandskillsnecessarytomeetcommonlyidentifiedneedsandproblems.Priortothe2016legislative session, Georgia had four study committees pertaining to issues of children’s behavioral health. In the 2015 House Study Committee on Children’s Mental Health report, it was noted that in Georgia, there were only six graduating child psychiatrists per year (Children’s Mental Health StudyCommittee,2015)andthatfamiliesfaceddifficultieswhentryingtoaccesschildpsychiatrists and psychologists. The committee recommended strategies to address workforce shortages, including education incentives, expanded behavioral health training for primary care providers, the creation of a clearinghouse of best practices, and coordinated training activities. The IDT has incorporated several of the recommendations into this plan.

Action Item 3.1.1 Prioritize specialties to increase workforce capacity in strategic subject areas (e.g., autism, suicidality, trauma)

Action Item 3.1.2 Identify targeted workforce segments to support with education/ financialincentives(e.g.,pediatricians,psychologists,teachers)

Action Item 3.1.3 Identify the method to bring this to scale

Georgia has already taken some steps to help alleviate the workforce shortage; however more progress is required to meet the state’s growing child and family needs. To provide critical services, targeting segments of the workforce, including psychologists, psychiatrists, and psychiatric nurse practitioners,foreducationalandfinancialincentivesinexchangefortheirservicescouldboostaccess to these much-needed professionals. In order to meet the needs of the entire state, these incentives will need to be funded and sustained. This was also recommended in the 2015 House study committee report, and it was recommended that the mental health workforce development initiatives offer loan forgiveness in exchange for a minimum of three years of work solely with Georgia’s children. Additionally, the report recommended the development of a community psychiatry fellowship program funded with a private-public partnership.

Strategy 3.2 Develop a clearinghouse of evidence-based/evidence-informed edu cational materials related to children’s behavioral health

Although several groups house information on evidence-based and evidence-informed practice with children and families, state and partner agencies do not currently have access to a clearinghouse of organized and updated information related to children’s behavioral health.

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To ensure that the behavioral health workforce has access to quality training materials and evidence-based practices, it is worth the investment for the state partners to obtain and maintain this information so that it is readily available.

Action Item 3.2.1 Identify if a clearinghouse resource is available in Georgia or elsewhere

Action Item 3.2.2 Develop a list of existing clearinghouse resources; determine the evidence-based practice criteria for inclusion/exclusion

Action Item 3.2.3 Determine where the clearinghouse will be housed, who will maintain the site, and how information will be disseminated

Inanefforttostreamlinetheworkandinformsharing,theIDTproposestofirstresearchexisting clearinghouse resources. Instead of creating a clearinghouse themselves, the IDT proposes the creation of a list and linkage to existing evidence-based practice clearinghouse resources on the SOC website. Even this will require housing and maintenance, and the group will need to determine who will house and maintain this site.

Strategy 3.3 Explore issues of scope of practice related to workforce shortages

As the statewide group of experts, the IDT is well-positioned to understand workforce issues as they relate to scope of practice. Given the workforce shortage, it would be helpful to determine what skillsetsareneededtomeettheneedsofchildrenandfamilies,andensurethatthoseinthefieldhave those skill sets through continuing education or licensure requirements.

Action Item 3.3.1 Research issues related to scope of practice

Action Item 3.3.2 Create a position paper related to policies that impact scope of practice

AswithmanyoftheproposedactionitemsintheSOCplan,itwillfirstbeimportanttounderstandwhat issues are related to scope of practice. Once these are more thoroughly understood, the IDT will propose recommendations aimed at leveraging policy and training opportunities to address scope of practice issues.


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Strategy 3.4 Targeted expansion of education/financial incentives to address behavioral health workforce shortages

To truly have an informed, adequately trained workforce to meet the needs of children and their families, better coordination will need to exist between the state agencies serving these children. The 2015 House study committee also called for the creation of a state mental health workforce plan across state agencies with a managed and budgeted scale-up plan that included the following as mental health service professionals: psychiatrists, psychologists, clinical social workers, mental health counselors and therapists, school nurses, school psychologists, and school social workers.

Action Item 3.4.1 Examine opportunities for the sharing of knowledge and alignment of training strategies across systems (i.e., trauma-informed care)

Action Item 3.4.2 Identify the shared core competencies across partner child-serving agencies

Action Item 3.4.3 Draft state mental health workforce plan across IDT agencies and get feedback from agencies

In addition to a comprehensive State Mental Health workforce plan, it will be important that partner agencies begin to share resources and expertise. State agencies should come together to identify core, shared competencies across agencies and ensure accessibility and quality workforce development and training activities. The following core competencies in children’s mental health have been identifiedbytheUniversity of Maryland: cultural and linguistic competence; child development and disorders; youth and families as partners; screening, assessment, and referrals; treatment plan-ning and service provision; outcomes and quality management; behavior management; health and safety; community development; and communication (Maryland Children’s Cabinet, 2008). These competencies are necessary across all child-serving agencies, and coordination could lead to a more efficientandlesscostlyworkforcedevelopmentplan.

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Focus Area 4: Funding and Financing

Goal statement: Utilize financing strategies to support and sustain a comprehensive, community-based, family-driven, youth-guided, culturally competent, and trauma-informed System of Care anchored in cross-agency commitment to effective and efficient spending.

Short-term Strategies Long-term Strategies4.1 Interagency funding of the IDT as the

oversight body for SOC in Georgia4.4 Reviewfinancialmappingreports

and implement recommendations from these (look for opportunities to braid or blend funding)

4.5 IDT agencies will collaboratively plan, apply for, and release funding opportunities and procurements when behavioral health is a key component.

4.2 Interagency funding of the COE to support training, education, and evaluation related to SOC

4.3 SOC philosophies and outcomes are incorporated in current and future procurement/contracting throughout all child-serving agencies represented on the BHCC

In order for a comprehensive, community-based, family-driven, youth-guided, culturally competent, and trauma-informed SOC framework to operate in Georgia, there must be a cross-agencycommitmenttoeffectiveandefficientspending.InSFY2014,Georgiastateagencies spent a combined estimated $379 million on approximately 100,395 children and youth with SED (Georgia Health Policy Center COE, 2014). Roughly two-thirds of this money was state funds. Although there have been some efforts over the years to optimize behavioral health spending between the child-serving agencies, to date, there has been no overarching plan to guide the agencies toward more deliberate, concrete collective action.

The braiding and blending of interagency funds is a key way for multiple agencies to achieve more effectiveandefficientspending.Blendingoffundsoccurswhentwoormorefundingsourcesareusedtofundaspecificpartofaprogram,whilebraidingoffundsreferstowhentwoormorefunding sources are coordinated to support the total cost of a service (Wallen & Hubbard, 2013). These methods allow for decreased funding duplication through improved resource coordination.Inaddition,theyallowincreasedstabilitythroughdiversifiedfundingsources.Accordingly, all strategies in this Funding and Financing section incorporate an element of interagency braiding or blending of funding. Short-term strategies 4.1 and 4.4 propose interagency funding for IDT and SOC training, education, and evaluation. Long-term strategies 4.4 and 4.5 aim to identify additional opportunities for braiding and blending funding, as well as collaborative funding opportunities. Additionally, short-term strategy 4.3 proposes a collective approach to embedding SOC objectives within relevant state vendor procurements and contracts. Through implementation ofthesefivestrategies,Georgiawillmoveclosertoitsgoalofmoreeffectiveandefficientspending,within a SOC framework, in order to support its children with behavioral health needs.


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Strategy 4.1 Interagency funding of the IDT as the oversight body for SOC in Georgia

For over six years, the IDT, composed of representation from Georgia’s child-serving agencies, providers, families, and youth, has served as the state’s SOC oversight body. In spite of IDT’s varied membership,leadership,andinitiatives,whichbenefittheentirestateacrossagencies,DBHDDhasservedasthesolefunderofthegroupsinceitsinception.Thisincludesfinancingallrelatedadministrative, project management, and research support.

FortheIDTtocontinueitssuccessfulSOCworkwithinGeorgia,itsfinancingshouldbesupportedbyvariedstateagenciesforthreekeyreasons:First,ifallagenciesaretobenefitfromIDT’ssuccess, all agencies should help to fund its work. Second, multiple contributors will diversify the funding stream and may increase the group’s ability to sustain itself beyond a single donor’s ability to pay and enhance its ability to garner additional grant funding. Third, and perhaps most importantly, equity in funding would support parity among agency members within the collabora-tive. A collaborative with only one funding member may result in a perceived (or real) imbalance in the partnership. The IDT, as an independent body, would have an increased ability to make changes based on the needs of the youth and families and within the SOC framework. Therefore, in order for IDT to ensure its continued sustainability and success, and have its funding be truly reflectiveofthecollaborativethatitis,allagencymembersshouldsupportthegroupanditsnu-merousbeneficialinitiativesthroughfinancialcontributions.

Action Item 4.1.1 Request that each child-serving agency member of the BHCC financiallysupporttheoperationofIDT

IDT state agency members will work together to design a request for funding from their respective agencies.Thisprocesswillincludeidentifyingafiscalagent,determiningthenecessaryagreements,exploring potential funding mechanisms (state budget line item v. separate agency contributions), and other key details. IDT state agency members will design this request together while concurrentlygatheringfeedbackfromtheexecutiveleadershipoftheirrespectiveagencies.Oncetheofficialrequest has been drafted by IDT, the IDT chair and co-chair will present the request to the BHCC. The BHCC will be asked to determine the best funding mechanism. IDT state agency members will incorporateandalignBHCCandindividualagencycommissionerfeedbackintoafinaldocument.StateagencymemberswillfollowthroughwiththefinalrecommendationsoftheBHCCandfacili-tate the development and execution of funding agreements.

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Strategy 4.2 Interagency funding of the COE to support training, education, and evaluation related to SOC

TheGeorgiaSOCStatePlanidentifiesworkforcedevelopment,includingeducationandtraining(Focus Area 3, pp. 32), general stakeholder education on value of provision of services within a SOC framework (Focus Area 2, pp. 28), and evaluation (Focus Area 5, pp. 42) as some of the key areas for action to improve Georgia’s SOC. The SOC framework requires a broad workforce that is properly trained in children’s behavioral health best practices in key areas such as trauma, cultural competency, mental health education, suicide prevention, etc. Additionally, it is critical that broad stakeholders (beyond the typical mental health service providers) are educated about the value of the provision of services within a SOC framework and what is needed to support this approach.

The COE, housed within Georgia State University’s Georgia Health Policy Center, works in close partnershipwithDBHDDtoprovidefidelitymonitoring,programevaluation,policyandfinancinganalysis, workforce development and training, and quality improvement technical assistance (TA) within a SOC framework, for the child and adolescent behavioral health system in Georgia. As a university partner already active in SOC-related training, education, and evaluation, as well as IDT facilitation, the COE is a natural collaborator for further work in this area.

Braiding or blending interagency funds to expand the COE’s SOC-related training, education, and evaluation activities will allow the system as a whole, as well as multiple child-serving agencies, to benefitintheseareas.Moreover,allowingSOC-relatedtraining,education,andevaluationeffortsto be led by one organization will increase state agency coordination and decrease duplication of efforts and resources in these areas.

Action Item 4.2.1 Develop a cost proposal to conduct coordinated training, TA, and evaluation activities that support multiple state agencies

Action Item 4.2.2 Present to BHCC for funding request/discussion

Action Item 4.2.3 Develop MOUs between DBHDD and child-serving agencies for allocated amount

IDTmemberswilldevelopacostproposalthatidentifiesthegeneralscopeofwork;amountoffunding required to carry out coordinated SOC-related training, TA, and evaluation activities that support multiple state agencies; and a mechanism for the repository of the funding to be allocated.ThecostproposalwilltakeintoaccountthefinalfundingmechanismdeterminedunderStrategy 4.1, and if possible, coordinate. This cost proposal/request for funding will be presented to the BHCC for discussion and eventual approval. Using the cost proposal as a guide, the MOU willbedeveloped,andagencieswilltakethenecessarystepstofollowthroughwiththeirfinancialcommitments. IDT state agency members will track and facilitate this process at their respective agencies.


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Strategy 4.3 Create and utilize SOC guiding principles for contract development

The IDT strongly believes in the value of SOC as a framework for service delivery. Therefore, IDT believes that incorporating SOC philosophies and outcomes into current and future relevant procurement and contracting activities and documents for BHCC-member child-serving agencies (whether conducted through the Department of Administrative Services (DOAS) or individual agencies) will better ensure that wherever possible, vendors support the state in achieving its SOC-related goals. IDT’s breadth and depth of knowledge about children’s behavioral health, Georgia’s CAMH system, and the SOC framework make it the appropriate partner to draft policy and procedure recommendations in this area.

Action Item 4.3.1 IDT subcommittee will research contractual language at each agency

Action Item 4.3.2 IDT will develop policy/procedure recommendations of SOC universal language to be adopted by BHCC to meet this strategy

Action Item 4.3.3 IDT will solicit BHCC to adopt policy/procedure recommendations to ensure that SOC philosophies and outcomes are incorporated in current and future procurement/contracting

In order to carry out this strategy, an IDT subcommittee will be formed to research and compile informationonrelevantcontractingproceduresateachagency.Basedonthesefindings,IDTwilldevelop policy and procedure recommendations for how SOC philosophies and outcomes could beincorporatedintocurrentandfutureprocurementandcontractingactivities(includingspecificlanguage for inclusion in contracts and requests for proposals) and present these recommendations to the BHCC. IDT will work with BHCC to incorporate feedback and implement agreed-upon policies within each agency, as well as DOAS.


Strategy 4.4 Review financial mapping reports and implement recommendations from these (look for opportunities to braid or blend funding)

DBHDDhaspreviouslydevelopedfinancialmappingreports,whichtraceamountsandflowoffunding from all relevant state agencies, for services and supports for children in Georgia with SED. In addition to outlining the current funding structure and dollars for SED services and supports, these reports highlight existing braiding of funding and opportunities for future braiding or blending of funding in the state.

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Action Item 4.4.1 Review previous mapping reports

Action Item 4.4.2 Update mapping reports

Action Item 4.4.3 IDT will develop recommendations to be presented to the BHCC

Asafirststep,theIDTwillreviewexistingfinancialmappingreports,mergecontent,andupdatewhere possible. Next, using these reports as a base, the IDT will identify opportunities for the state to braid or blend funding for SED services and supports, make recommendations to the BHCC, and work to implement approved recommendations within relevant agencies.

Strategy 4.5 IDT agencies collaboratively plan and apply for and release funding opportunities and procurements when behavioral health is a key component

The federal government, private foundations, and other organizations provide a variety of funding opportunities to support child and adolescent behavioral health within a SOCframework at the state and local level. Historically, many Georgia state agencies have applied for these opportunities separately, and sometimes without coordination. In some cases, this has resulted in duplicative or poorly coordinated efforts. However, more recently, IDT has become a platform for agencies to announce their interest in, coordinate applications for, and serve as advisory interagency bodies for funding. As a result, a number of successful grants and outcomes have ensued. In order to further this coordination between state agencies, maximize resources, and increase impact, IDT would like to grow its ability to collaboratively plan and apply for child and adolescent behavioral health funding.

Additionally, state agencies provide a number of separate child and adolescent behavioral health funding opportunities for service providers, education and advocacy organizations, and other nongovernmental organizations. Greater interagency coordination with respect to these funding opportunities (including pooling funding to offer larger or longer awards, or simply supporting each other’s funding efforts through partnership) could increase the possibility for more sustained, successful outcomes among awardees and the children they serve.

Action Item 4.5.1 Potential investment in COE position (grant developments and maintaining relationships with foundations and other potential funding sources)

Action Item 4.5.2 Compilation of budget and develop job description (researching grant and other funding opportunities)

Action Item 4.5.3 Executeanongoingstrategicfinancingplan(encompassingpublic,private, and grant funding) to support SOC improvement


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In order to achieve this level of coordination, IDT would research and pursue the possibility of creating and jointly funding a dedicated grant manager position (possibly housed at the COE), to have primary responsibility for developing state agency grant opportunities for child and adolescent behavioral health within the SOC framework. The position’s work would include identifying and responding to funding requests for proposals and maintaining relationships with foundations and other potential funding sources. If IDT determines that this position should be created, the group will work to further outline the details of the job (including creating a job description, budget, initial duration of position and funding, and where the position will be housed) and seek appropriate approval from relevant state agencies, and the BHCC if needed. To sustain the workofthegroup,anongoingstrategicfinancingplanwouldbenecessaryandshouldbecreatedand reviewed annually.

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Focus Area 5: Evaluation

Goal statement: Utilize a framework of measuring and monitoring data on key SOC outcomes to demonstrate and communicate the value of a SOC approach for improving children’s behavioral health, and support ongoing quality and improvement.

Short-term Strategies Long-term Strategies5.1 The IDT will review SOC Evaluation

tools to identify key metrics applicable to Georgia

5.3 The IDT will institute and maintain a continuous quality-improvement processutilizingidentifiedmetricsthat will be reviewed annually and will regularly be reported to the BHCC

5.2 Provide tools to Local Interagency Planning Teams (LIPTs), Regional Interagency Action Teams (RIATs), and other child-serving systems to self-evaluate System of Care outcomes

EvaluationEvaluation activities are important to ensure that SOC values are present in the activities outlined in this plan, and the goals, strategies, and action items are not only situated with the SOC framework but are also effectively reaching the goals and improving services for children and families. Evaluation, as a core component of the SOC State Plan, does not relate directly to any one focus area, strategy, or action item, but rather to the plan as a whole.


Strategy 5.1 The IDT will review SOC Evaluation tools to identify key metrics applicable to Georgia

Review key metrics applicable to Georgia and SOC Evaluation practices.


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Action Item 5.1.1 Limited environmental scan of measures in Georgia and other states

Action Item 5.1.2 Reach out to TA Network and SAMHSA for support and expertise

Action Item 5.1.3 Finalize what IDT chooses to utilize

Measures of effective services within the SOC framework have been created and are utilized in otherstates.Inanefforttobeefficientandnotduplicative,IDTwillcompleteabriefenvironmentalscan of measures used in other states and determine the best measures for Georgia. IDT will reach out to the TA Network and SAMHSA for their expertise and guidance, and determine the best possible option for Georgia.

Strategy 5.2 Provide tools to LIPTs, RIATs, and other child-serving systems to self- swevaluate their Systems of Care outcomes

The IDT will utilize evaluation tools to monitor the child-serving system in Georgia as a whole; however it will be important for local and regional bodies to perform evaluation activities as well that can feed back into quality-improvement efforts. The IDT will also identify tools that are appropriate for local and regional systems, develop tools and trainings around these tools, provide for a plan to distribute these, and provide for evaluation TA for local and regional SOC bodies.

Action Item 5.2.1 Develop materials and trainings

Action Item 5.2.2 Disseminate tools

The IDT will also identify tools that are appropriate for local and regional systems, provide for the development of trainings around these tools, provide for a plan to distribute these regionally and locally, and provide for evaluation TA for local and regional SOC bodies.

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Strategy 5.3 The IDT will institute and maintain a continuous quality-improvement process utilizing identified metrics that will be reviewed annually and will regularly be reported to the BHCC

IDTwillcometogethertodefineaquality-improvementprocessusingthemetricsidentifiedintheshort-termgoals.TheseprocesseswillbedefinedandreportedtotheBHCCtodemonstratethe success of the SOC State Plan implementation.

Action Item 5.3.1 TheIDTwillincorporatethemetricsidentifiedintheshort-termgoalsinto a quality-improvement process

Action Item 5.3.2 Metrics will be reviewed annually and reported back to the BHCC for input and guidance

Action Item 5.3.3 The IDT will provide for continuous TA to local Systems of Care in sustaining a service-delivery system based on SOC principles

Oncemeasurementtoolsareidentified,thegrouphaschosenthosethataremostappropriate,andtrainings have been developed and disseminated to local and regional SOC bodies, it will be important to identify challenges and opportunities via the communication feedback loops created in the coordination section of the plan. The BHCC will continue to provide high-level support and guidance to the IDT work, which will be informed by the SOC metrics. Additionally, it will be important for local SOC bodies to continue to monitor and evaluate their own systems, so the IDT will provide for a mechanism for the provision of continued TA around local evaluation.


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Implementation Plan and TimeframeThe following pages outline a high-level implementation plan and timeframe. The IDT tracks its work utilizing work plans, which are much more detailed, living documents. The work plans include responsible parties, deadlines, action items, and next steps. The implementation plan guides the quarterly work of the group.

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Key:

· Ongoing Operation/Worko Initiate Processv Plan/Report √ Action Complete

Action Item by Strategy and Focus AreaSFY 2018 SFY

2019SFY

2020

Q1 Q2 Q3 Q4

Focus Area 1. Access

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1.1 Service mapping for behavioral health service utilization

1.1.1

Utilize the following data sources: DCH/DBHDD and Voices, MH professional shortage areas; analyze by service area and county; identify proxies for key indicators to track and share

o • • v

1.1.2 Create a centralized location for data sources o √

1.2 Increase behavioral health services available in schools

1.2.1Establish a baseline measure of schools that identify as having access to all three tiers of school-based mental health services

o • • v

1.2.2 Increase the number of schools with access to all three tiers of school-based mental health services o • • • •

1.2.3 Increase the number of students receiving services in the school setting o • • • •

1.3 Improve families’ abilities to navigate the current system

1.3.1 Create resource tools for families and youth o • • v

1.3.2 Create an orientation to services for families and youth for each IDT member agency o • • •

1.3.3 Create resources for youth ages 18-21 to assist with self-navigation of services o • • v

1.4 Increase utilization of Intensive Care Coordination (IC-3) services

1.4.1 Add this service to the Medicaid State Plan o √

1.4.2 Produce baseline utilization data for year 2016 to create a benchmark o • v

1.4.3 Train providers on this service model o • √

1.4.4 Perform quality assurance activities to ensure fidelity;usedatafordecision-makinginplace o • • • • •


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2019SFY

2020

Q1 Q2 Q3 Q4

Long

-ter

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1.5 Utilize data to inform a strategic approach to access

1.5.1Compile data from strategy 1.1 and create a communication and dissemination plan o •

1.5.2Share information with key stakeholders that caninfluencetheaccessprocess(purchasingauthorities and state agencies)

o •

1.5.3 Utilize data to develop recommendation for improved care o •

1.6 Recruit practitioners to shortage areas

1.6.1 Research shortage area plan from other states and Georgia o • v

1.6.2

Work with schools of social work, psychology, etc. to identify incentives and ensure training programs address the needs of youth and families in shortage areas

o • •

1.6.3 Increase the number of peer specialists for parents and youth throughout the state o • • v • •

1.7

Support continuity of care by addresing continuity of eligibility for Medicaid(address children and youth going on and off the Medicaid rolls)

1.7.1Provide more resources for training, navigation, and paid eligibility workers in social service agencies

o √

1.7.2 Provide support and education about eligibility for youth aging out of foster care o √

1.7.3 Create baseline data; evaluate improvement annually o √

1.8Strategically increase the use of telemedicine/telehealth services within child-serving agencies

1.8.1Service mapping of behavioral health services provided through telemedicine (subset of 1.1 usingaGTbillingmodifier)

o • v

1.8.2 Current status scan on public payer policy on the use of telemedicine o • v

1.8.3 Mapping of where telemedicine facilities are located for behavioral health services o • v

•

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2019SFY

2020

Q1 Q2 Q3 Q4

Focus Area 2: Coordination

Long

-ter

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ort-

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Str

ateg

ies

2.1 Build and maintain feedback loops between local, regional, and state agencies and systems

2.1.1Create and distribute a list of all LIPT chairs to all SOC partners o • •

2.1.2Identify a point person to facilitate organizational structure and communication among and between LIPTs, RIATs, IDT, and the BHCC

o • •

2.1.3Create a communication protocol and template among and between the LIPTs, RIATs, IDT, and the BHCC

o v

2.2 Increase training on SOC principles for all stakeholder groups

2.2.1Developuniformdefinitionofcarecoordinationfor CMOs and operationalize roles for all agencies and stakeholder groups

o • v • v

2.2.2Collect all information/training materials about SOC and care coordination across member organizations

o √

2.2.3Create new or modify existing trainings for LIPTs, LIPT chairs, RIATs, and other groups on the Systems of Care approach

o √

2.2.4

Create and disseminate new culturally and linguistically appropriate materials for parents, caretakers, and family members about the SOC approach

o • •

2.3

Create and utilize a common language for discussing SOC principles and making the business case to internal and external stakeholders

2.3.1 Developapocketguide/dictionarytodefineanddescribe SOC language o • v

2.3.2 Disseminate the guide widely through trainings and conferences, including the SOC Academy o •

2.4

Address gaps in the crisis continuum by adding additional levels of care that will address capacity and acuity concerns: Crisis Respite; IC3; therapeutic foster homes

2.4.1 Develop a network of therapeutic foster homes o •

2.4.2 Develop a step-down level of care between that of a PRTF and therapeutic foster home o •


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2019SFY

2020

Q1 Q2 Q3 Q4

Focus Area 3: Workforce Development

Long

-ter

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ort-

term

Str

ateg

ies

3.1Targeted expansion of education/financial incentives to address behavioral health workforce shortages

3.1.1Prioritize specialties to increase workforce capacity in strategic subject areas (e.g., autism, suicidality, trauma)

o • √

3.1.2Identify targeted workforce segments to support witheducation/financialincentives(e.g.,pediatricians, psychologists, teachers)

o • √

3.1.3 Identify the method to bring this to scale o v v √ v

3.2Develop a clearinghouse of evidence-based/evidence-informed educational materials related to children’s behavioral health

3.2.1 Identify if a clearinghouse resource is available in Georgia or elsewhere o • √

3.2.2Develop a list of existing clearinghouse resources; determine the evidence-based practice criteria for inclusion/exclusion

o • v

3.2.3Determine where the clearinghouse will be housed, who will maintain the site, and how information will be disseminated

o √ • • •

3.3 Explore issues of scope of practice related to workforce shortages

3.3.1 Research issues related to scope of practice o • •

3.3.2 Create a position paper related to policies that impact scope of practice o • v √

3.4Develop a state mental health workforce plan across IDT agencies with a managed and budgeted scale-up plan

3.4.1Examine opportunities for the sharing of knowledge and alignment of training strategies across systems (i.e., trauma-informed care)

o • • • v

3.4.2 Identify the shared core competencies across partner child-serving agencies o • • • √

3.4.3 Draft state mental health workforce plan across IDT agencies and get feedback from agencies

o v v

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2019SFY

2020

Q1 Q2 Q3 Q4

Focus Area 4: Funding and Financing

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4.1 Interagency funding of the IDT as the oversight body for SOC in Georgia

4.1.1Request that each child-serving agency member oftheBHCCfinanciallysupporttheoperationofthe IDT

o v √

4.2Interagency funding of the COE to support training, education, and evaluation related to SOC

4.2.1Develop a cost proposal to conduct coordinated training, TA, and evaluation activities that support multiple state agencies

o √

4.2.2 Present to BHCC for funding request/discussion v

4.2.3 Develop MOUs between DBHDD and child-serving agencies for allocated amount v √

4.3 Create and utilize SOC guiding principles for contract development

4.3.1 IDT subcommittee will research contractual language at each agency o

4.3.2IDT will develop policy/procedure recommendations of SOC universal language to be adopted by BHCC to meet this strategy

o

4.3.3

IDT will solicit BHCC to adopt policy/procedure recommendations to ensure that SOC philosophies and outcomes are incorporated in current and future procurement/contracting

v


51


2019SFY

2020

Q1 Q2 Q3 Q4

Long

-ter

m S

trat

egie

s

4.4

Review financial mapping reports and implement recommendations from these (look for opportunities to braid or blend funding)

4.4.1 Review previous mapping reports o

4.4.2 Update mapping reports •

4.4.3 IDT will develop recommendations to be presented to the BHCC v √ v

4.5

IDT agencies collaboratively plan, apply for, and release funding opportunities and procurements when behavioral health is a key component

4.5.1Potential investment in COE position (grant developments and maintaining relationships with foundations and other potential funding sources)

o • • v √

4.5.2Compilation of budget and crafting job description (researching grant and other funding opportunities)

o v √

4.5.3Executeanongoingstrategicfinancingplan(encompassing public, private, and grant funding) to support SOC improvement

o

52


2019SFY

2020

Q1 Q2 Q3 Q4

Focus Area 5: Evaluation

Long

-ter

m S

trat

egie

s Sh

ort-

term

Str

ateg

ies 5.1 The IDT will review SOC Evaluation tools to

identify key metrics applicable to Georgia

5.1.1Limited environmental scan of measures in Georgia and other states o

5.1.2 Reach out to TA Network and SAMHSA for support and expertise o

5.1.3 Finalize what IDT chooses to utilize √

5.2Provide tools to LIPTs, RIATs, and other child-serving systems to self-evaluate their Systems of Care work

5.2.1 Develop materials and trainings o • • • √

5.2.2 Disseminate tools • •

5.3

The IDT will institute and maintain a continuous quality-improvement process utilizing identified metrics that will be reviewed annually and will regularly be reported to the BHCC

5.3.1 Usetoolsidentifiedinshort-termgoals • o

5.3.2 Create protocol for reviewing self-evaluation of local SOC to determine TA needs o •

5.3.3 Continuous TA for local SOC bodies to ensure that SOC values are present •


53

Summary Table of Strategies, Goals, and Action ItemsCost: Symbols assigned based on low cost ($), Moderate Cost ($$), or High Cost ($$$, $$$$)

Access Cost Outcomes

Strategy 1.1 Service mapping for behavioral health service utilizationAction Item 1.1.1 Utilize the following data sources: DCH/DB-HDD and Voices, MH professional shortage areas; analyze by service area and county; identify proxies for key indicators to track and share

$

Service map of behavioral health providers and utilization patterns

Action Item 1.1.2 Create a centralized location for data sources $ $

Centralized data hub realized

Strategy 1.2 Increase behavioral health services available in schoolsAction Item 1.2.1 Establish a baseline measure of schools that self-identify as having access to all three tiers of school-based mental health services

$Baseline report about SBMH services in the state

Action Item 1.2.2 Increase the number of schools with access to all three tiers of school-based mental health services

$ $More schools with all three tiers of SBMH services available

Action Item 1.2.3 Increase the number of students receiving services in the school setting

$ $Increased number of students served in the school setting

Strategy 1.3 Improve families’ abilities to navigate the current systemAction Item 1.3.1 Create resource tools for families and youth $

Resource tools available

Action Item 1.3.2 Create an orientation to services for families and youth for each IDT member agency $

Family orientation tools created

Action Item 1.3.3 Create resources for youth ages 18-21 to assist with self-navigation of services

$Resource tools created and disseminated

54

Strategy 1.4 Increase utilization of Intensive Care Coordination (IC-3) servicesAction Item 1.4.1 Add this service to the Medicaid State Plan $

IC is part of Medicaid State Plan

Action Item 1.4.2 Produce baseline utilization data for year 2016 to create a benchmark

$ Baseline report, benchmark created

Action Item 1.4.3 Train providers on this service model $ $

Trainings created, disseminated

Action Item 1.4.4 Perform quality-assurance activities to ensurefidelity;usedatafordecision-makinginplace

$ $

Ongoing QA process implemented

Strategy 1.5 Utilize data to inform a strategic approach to accessAction Item 1.5.1 Compile data from strategy 1.1 and create a communication and dissemination plan

$Communication and dissemination plan created

Action Item 1.5.2 Share information with key stakeholders that caninfluencetheaccessprocess(purchasingauthorities and state agencies)

$ Stakeholders have access to information

Action Item 1.5.3 Utilize data to develop recommendations for improved care

$ Recommendations are developed by the IDT

Strategy 1.6 Recruit practitioners in shortage areasAction Item 1.6.1 Research shortage area plan from other states and Georgia

$Short report created

Action Item 1.6.2 Work with schools of social work, psychology, etc. to identify incentives and ensure training programs address the needs of youth and families in shortage areas.

$ $

Incentives for schools are developed

Action Item 1.6.3 Increase the number of peer specialists forparentsandyouth(CPS-YsandCPS-Ps) throughout the state

$ $

MoreCPS-YandCPS-Psare available throughout the state


55

Strategy 1.7 Support continuity of care by addressing continuity of eligibility for Medicaid (address children and youth going on and off the Medicaid rolls)Action Item 1.7.1 Provide more resources for training, navigation, and paid eligibility workers in social service agencies

$Training materials are available for workers in social service agencies

Action Item 1.7.2 Provide support and education about eligibility for youth aging out of foster care $ $ $

Training materials available; training and support available to transitioning youth

Action Item 1.7.3 Create baseline data; evaluate improvement annually

$ $Data is created and made available via report, updated annually

Strategy 1.8 Strategically increase the use of telemedicine/telehealth services within child-serving agenciesAction Item 1.8.1 Service mapping of behavioral health services provided through telemedicine (subset of 1.1 usingaGTbillingmodifier)

$Service maps are available

Action Item 1.8.2 Current status scan on public payer policy on the use of telemedicine

$ Scan complete; report available

Action Item 1.8.3 Mapping of where telemedicine facilities are located for behavioral health services

$ Map created; map available

56

Coordination Cost Measures

Strategy 2.1 Build and maintain feedback loops between local, regional, and state agencies and systemsAction Item 2.1.1 Create and distribute a list of all LIPT chairs to all SOC partners $

Online list/resource

Notificationofreceiptbypartners

Action Item 2.1.2 Identify a point person to facilitate organizational structure and communication among and between the LIPTs, RIATs, IDT, and the BHCC

$ $

Hiring of one FTE SOC PM

Structure/outline developed

Action Item 2.1.3 Create a communication protocol and template among and between the LIPTs, RIATs, IDT, and the BHCC $

Protocol developed and disseminated to partners

Adoption of protocol

Adherence to protocol among all entities

Strategy 2.2 Increase training on SOC principles for all stakeholder groupsAction Item 2.2.1 Developuniformdefinitionofcarecoordination for CMOs and operationalize roles for all agencies and stakeholder groups $

Creation of uniform definition

Training and refresher training for agencies and stakeholders

Action Item 2.2.2 Collect all information/training materials about SOC and Care Coordination across member organizations

$ $Database of training materials

Action Item 2.2.3 Create new or modify existing trainings for LIPTs, LIPT chairs, RIATs, and other groups on the Systems of Care approach

$

Updated training manual

Training calendar for chairs and team members

Incentives developed for the chairs to travel for organization to approve time away


57

Action Item 2.2.4 Create and disseminate new culturally and linguistically appropriate materials for parents, caretakers, and family members about the SOC approach $ $

Printed materials for family members and stakeholders

Number of SOC materials created and received by family members and guardians

Strategy 2.3 Create and utilize a common language for discussing SOC principles and making the business case to internal and external stakeholdersAction Item 2.3.1 Developapocketguide/dictionarytodefineand describe SOC language

$Pocketguidetemplate/finaldoc

Action Item 2.3.2 Disseminate the guide widely through trainings and conferences, including at the SOC Academy

$ $

Number of guides disseminated

Number of agencies implementing use of guide

Strategy 2.4 Address gaps in the crisis continuum by adding additional levels of care that will address capacity and acuity concerns: Cri-sis Respite; IC3; Therapeutic Foster Homes (TFH)Action Item 2.4.1 Develop a network of therapeutic foster homes

$ $ $ $

Increase in funding to support TFH

Creation of network of homes

Number of households with trained family members

Number of families enrolled in TFH program

Number of trainings conducted for TFH

Action Item 2.4.2 Develop a step-down level of care between that of a PRTF and therapeutic foster home

$ $ $

Policy developed

Number of clinicians/mental health professionals hired and/or trained

% of clinicians using new level of care

lorisolomon

Sticky Note

JANA, What happened to Strategy 2.5 and action items.

58

Workforce Development Cost Measures

Strategy 3.1 Targeted expansion of education/financial incentives to address behavioral health workforce shortagesAction Item 3.1.1 Prioritize specialties to increase workforce capacity in strategic subject areas (e.g., autism, suicidality, trauma)

$Determine preferred ratio of specialty providers to patient population

Action Item 3.1.2 Identify targeted workforce segments to supportwitheducation/financialincentives(e.g.,pediatricians, psychologists, teachers)

$ List of providers who are already successfully delivering specialty care in strategic subject areas

Action Item 3.1.3 Identify the method to bring this to scale

$ $

Report on ratio of providers, average salary, timeline to drive recruitment and workforce development activities for specialty care

Strategy 3.2 Develop a clearinghouse of evidence-based/evidence-informed educational materials related to children’s behavioral healthAction Item 3.2.1 Identify if a clearinghouse resource is available in Georgia or elsewhere $

Report or summary of existing resources; mine IDT membership for resources

Action Item 3.2.2 Develop a list of existing clearinghouse resources; determine the evidence-based practice criteria for inclusion/exclusion $

Consolidated list of resources

Formalized criteria for EBPs presented in a brief/report

Action Item 3.2.3 Determine where the clearinghouse will be housed, who will maintain the site, and how information will be disseminated

$ $

Formal agreement about which partner is responsible for housing and updating the information ($$ is dependent on resources and capacity of host organization; maintenance may contribute to accumulated higher cost over time)


59

Strategy 3.3 Explore issues of scope of practice related to workforce shortages

Action Item 3.3.1 Research issues related to scope of practice

$

Summary report of common issues related to scope of practice between children’s BH providers

Action Item 3.3.2 Create a position paper related to policies that impact scope of practice

$ Publication/dissemination of position paper

Strategy 3.4 Develop a state mental health workforce plan across IDT agencies with a managed and budgeted scale-up plan

Action Item 3.4.1 Examine opportunities for the sharing of knowledge and alignment of training strategies across systems (i.e., trauma-informed care)

$ $

Summary report prepared by COE or point person aggregating the training strategies from all the IDT departments

Action Item 3.4.2 Identify the shared core competencies across partner child-serving agencies

$

Included in summary report above

Number of trainings delivered and number of staff attending

Action Item 3.4.3 Draft state mental health workforce plan across IDT agencies and get feedback from agencies

$ $Workforce plan draft

60

Funding and Financing Cost Measures

Strategy 4.1 Interagency funding of the IDT as the oversight body for SOC in Georgia

Action Item 4.1.1 Request that each child-serving agency memberoftheBHCCfinanciallysupporttheoperation of IDT

$

Request to BHCC made (May 2017)

Financing obtained ($)

Strategy 4.2 Interagency funding of the COE to support training, education, and evaluation related to SOCAction Item 4.2.1 Develop a cost proposal to conduct coordinated training, TA, and evaluation activities that support multiple state agencies

$

Proposal developed by COE

Proposal approved by IDT

Action Item 4.2.2 Present to BHCC for funding request/discussion $

Proposal presented to BHCC

Funding granted by BHCC/Legislature ($)

Action Item 4.2.3 Develop MOUs between DBHDD and child-serving agencies for allocated amount $

MOUs are implemented among all child-serving agencies (number of MOUs executed)

Strategy 4.3 Create and utilize SOC guiding principles for contract development

Action Item 4.3.1 IDT subcommittee will research contractual language at each agency

$Sample language identified fromenvironmentalscan for adoption

Action Item 4.3.2 IDT will develop policy/procedure recommendations of SOC universal language to be adopted by BHCC to meet this strategy

$

IDT presents policy/pro-cedure recommendations to BHCC

BHCC adopts IDT proposed policy/procedure recommendationsNumber of contracts executed using contract language


61

Action Item 4.3.3 IDT will solicit BHCC to adopt policy/procedure recommendations to ensure that SOC philosophies and outcomes are incorporated in current and future procurement/contracting

$

BHCC adopts IDT proposed policy/procedure recommendations

Number of contracts that incorporate SOC outcomes/philosophies

Strategy 4.4 Review financial mapping reports and implement recommendations from these (look for opportunities to braid or blend funding)Action Item 4.4.1 Review previous mapping reports $

IDT indicates what elements of mapping report require updates

Action Item 4.4.2 Update mapping reports $ $

New mapping report completed

Action Item 4.4.3 IDT will develop recommendations to be presented the BHCC

$

Recommendations presented to BHCC

BHCC adopts IDT recommendations

Number of contracts/initiatives executed using blended and braided funds (#/$)

Strategy 4.5 IDT agencies collaboratively plan and apply for and release funding opportunities and procurements when behavioral health is a key component

Action Item 4.5.1 Potential investment in COE position (grant developments and maintaining relationships with foundations and other potential funding sources)

$ $

BHCC or Legislature allocates funds to support COE position (via IDT funding) ($)

Action Item 4.5.2 Compilation of budget and craft job description (researching grant and other funding opportunities)

$

Positionfilled

Action Item 4.5.3 Executeanongoingstrategicfinancingplan(encompassing public, private, and grant funding) to support SOC improvement

$

Funding secured ($) by type

62

Evaluation Cost Measures

Strategy 5.1 The IDT will review SOC Evaluation tools to identify key metrics applicable to GeorgiaAction Item 5.1.1 Limited environmental scan of measures in Georgia and other states $

Environmental scan complete, presented to IDT

Action Item 5.1.2 Reach out to TA Network and SAMHSA for support and expertise

$Guidance from TA Network, SAMHSA

Action Item 5.1.3 Finalize what IDT chooses to utilize $

Measure is chosen

Strategy 5.2 Provide tools to LIPTs, RIATs, and other child-serving systems to self-evaluate their Systems of Care work.Action Item 5.2.1 Develop materials and trainings

$ $

Tools for local systems identified,developed

Action Item 5.2.2 Disseminate tools $ $

Strategy 5.3 The IDT will institute and maintain a continuous quality-improvement process utilizing identified metrics that will be reviewed annually and will regularly be reported to the BHCC.Action Item 5.3.1 Usetoolsidentifiedintheshort-termgoalsinthe QI process

$Annual report to the BHCC for guidance

Action Item 5.3.2 Create protocol for reviewing self-evaluation of local SOC to determine TA Needs

IDT presents policy/pro-cedure recommendations to BHCC

Action Item 5.3.3 Continuous TA for local SOC bodies to ensure that SOC values are present


63

Summary and ConclusionsThis plan has been created by the IDT team and incorporated the work of representatives from the various child-serving agencies, provider groups, advocacy groups, care management organizations, partner organizations, family organizations, and our federal consultant, the CDC. The group has worked to identify high-leverage activities to further entrench the SOC approach into Georgia’s children’s behavioral health system to improve quality and access to appropriate services for Georgia’s families.

64

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Appendices

Appendix A. SOC Guiding Principles

• Members should have access to a comprehensive array of services that address their physical, emotional, social, and educational needs.

• Services and supports should utilize a child/ family/ person-directed focus on wellness and re-covery. Members should receive individualized services in accordance with their unique needs and guided by their individually tailored service plan.

• Choice by the individual, youth or family should be respected. And their human dignity valued.• The families and surrogate families of participants should be full participants in all aspects of

the planning and delivery of services, they (families) should be integrated into care whenever possible.

• Treatment and support services should be based on condition, and not on insurance status. • The rights of individual users should be protected and effective advocacy efforts promoted.

• Members should receive services within the least restrictive, most normative environment that is clinically appropriate.

• Enrollees should receive services without regard to race, religion, national origin, sex, physical disability, or other characteristics, and services should be sensitive and responsive to cultural differencesandspecificneeds.

• Participants should receive services that are integrated, with linkage between agencies and programs and mechanisms for planning, developing, and coordinating services.

• Members should be provided with a case manager or similar mechanism to ensure that multiple services are delivered in a coordinate way and therapeutic manner and which will allow them to move through the system of service in accordance with their changing needs.

• Thereshouldbea“nowrongdoor”approachsothatnomatterwhereanindividual,childoryouths enters the system, they are guided to the right provider that will address their unique needs.

• Earlyidentificationandinterventionforindividualsshouldbepromotedbysystemsofcareinorder to enhance the likelihood of positive outcomes.

• ChildrenandYouthshouldbeensuredsmoothtransitionstotheadultservicesystemas they reach maturity.

Child-, Family-, and Person-centeredness

Community based

Cultural competancy

Coordination